Survival against the odds

A patient who benefited from a new way of allocating donor livers, says he was ‘very lucky’ after a transplant operation saved his life.

Tejwant Sohal, 43, from Aylesbury, was part of a pilot study looking at whether patients with chronic liver disease who suddenly deteriorate – known as acute-on-chronic liver failure (ACLF) - would have a good chance of survival if given a transplant.

Previously, patients with this type of severe disease, many in their thirties or forties, would be deemed too sick to receive a donor liver. They often became too ill to survive a transplant or died before a suitable donor could be found, with 70% dying within 28 days.

But after falling gravely ill in 2021 because of his genetic condition cryptogenic cirrhosis, Tejwant made a recovery after receiving a transplant at the Royal Free Hospital (RFH) and he has returned to full-time work. 

Critically ill patients like Tejwant are now being prioritised as part of a planned national transplant programme.

NHS Blood and Transplant (NHSBT) introduced the changes to the way livers are allocated for ACLF patients following work by the NHSBT Liver Advisory Group and the UK’s seven liver transplant centres, including the Royal Free London.

The changes could save hundreds of lives in the UK each year.  

Details have been published today in the Lancet Regional Health and the life-saving approach is now being considered by other countries across the world. The new Lancet paper shows that when these patients were made one of the UK’s national priority groups for transplantation, more than three quarters (77%) of people with ACLF who were transplanted were still alive one year later.

Tejwant’s story

It was while he was waiting for a liver that Tejwant developed sepsis which triggered ACLF and he was placed in an induced coma. Following a recommendation from a panel of experts, he was placed on the pilot ACLF transplantation pathway – which meant he was first in line for a donor liver.

Tejwant said: “From what I understand some people thought I was too far gone to get a transplant. I’m so grateful to the doctors who advocated for me and pointed out that my vital signs, despite the infection, were strong. I’d also like to thank all the staff for looking after me so brilliantly.

“When I finally woke up a week after the transplant I was understandably very confused as I’d had no idea I’d even had a transplant as I’d been so poorly beforehand. I’d also lost many days pre transplant when I’d been in an induced coma battling sepsis.

“Thankfully I was lucky to make a very good recovery and the only symptom I sometimes get, which is from the medication, is occasional hand tremors. I was able to go back to work in property litigation just a few months after surgery.”

It is hoped that the new organ allocation system will also be adopted internationally, helping to save thousands of lives each year.

David Nasralla, consultant hepatologist and Tejwant’s transplant surgeon, said: “Tejwant was one of the first people to benefit from the study. Despite being so poorly, he was young and fit and was therefore deemed a good candidate for transplant. I am delighted that Tejwant was not only given the go ahead for a transplant but we were lucky enough to receive a donor in time.”

Tejwant added: “The donor’s family wrote to me a few months after the transplant and I wrote back. It is such a sad situation but it was good to hear a bit about the person who made this special gift possible and for me to be able to express my gratitude to their family. Despite everything that has happened to me I feel very lucky.”

Doug Thorburn, divisional director for liver and digestive health at the RFL, said: “The UK liver transplant community collaborated effectively to develop a way to prioritise these patients. This was transformative because there is no other effective treatment available.”

Pictured: Tejwant

Background information:

The ACLF pathway bridges the gap between the chronic liver disease list where patients wait anything from a few days to a year or two and a super urgent list where someone goes into liver

failure from an unknown cause and will automatically go to the top of the transplant list. Historically those on the chronic liver disease list were not able to switch to the super urgent list even if their condition deteriorated rapidly, which is the case with patients who develop ACLF.

Patients on the ACLF list still have to fulfil strict criteria. The patient has to have chronic liver disease and either be on the ICU or high dependency unit with only a 50% chance of surviving for 28 days. The patient’s case is then presented to a panel to make a decision on suitability for transplantation

A patient who benefited from a new way of allocating donor livers, says he was ‘very lucky’ after a transplant operation saved his life.

Tejwant Sohal, 43, from Aylesbury, was part of a pilot study looking at whether patients with chronic liver disease who suddenly deteriorate – known as acute-on-chronic liver failure (ACLF) - would have a good chance of survival if given a transplant.

Previously, patients with this type of severe disease, many in their thirties or forties, would be deemed too sick to receive a donor liver. They often became too ill to survive a transplant or died before a suitable donor could be found, with 70% dying within 28 days.

But after falling gravely ill in 2021 because of his genetic condition cryptogenic cirrhosis, Tejwant made a recovery after receiving a transplant at the Royal Free Hospital (RFH) and he has returned to full-time work. 

Critically ill patients like Tejwant are now being prioritised as part of a planned national transplant programme.

NHS Blood and Transplant (NHSBT) introduced the changes to the way livers are allocated for ACLF patients following work by the NHSBT Liver Advisory Group and the UK’s seven liver transplant centres, including the Royal Free London.

The changes could save hundreds of lives in the UK each year.  

Details have been published today in the Lancet Regional Health and the life-saving approach is now being considered by other countries across the world. The new Lancet paper shows that when these patients were made one of the UK’s national priority groups for transplantation, more than three quarters (77%) of people with ACLF who were transplanted were still alive one year later.

Tejwant’s story

It was while he was waiting for a liver that Tejwant developed sepsis which triggered ACLF and he was placed in an induced coma. Following a recommendation from a panel of experts, he was placed on the pilot ACLF transplantation pathway – which meant he was first in line for a donor liver.

Tejwant said: “From what I understand some people thought I was too far gone to get a transplant. I’m so grateful to the doctors who advocated for me and pointed out that my vital signs, despite the infection, were strong. I’d also like to thank all the staff for looking after me so brilliantly.

“When I finally woke up a week after the transplant I was understandably very confused as I’d had no idea I’d even had a transplant as I’d been so poorly beforehand. I’d also lost many days pre transplant when I’d been in an induced coma battling sepsis.

“Thankfully I was lucky to make a very good recovery and the only symptom I sometimes get, which is from the medication, is occasional hand tremors. I was able to go back to work in property litigation just a few months after surgery.”

It is hoped that the new organ allocation system will also be adopted internationally, helping to save thousands of lives each year.

David Nasralla, consultant hepatologist and Tejwant’s transplant surgeon, said: “Tejwant was one of the first people to benefit from the study. Despite being so poorly, he was young and fit and was therefore deemed a good candidate for transplant. I am delighted that Tejwant was not only given the go ahead for a transplant but we were lucky enough to receive a donor in time.”

Tejwant added: “The donor’s family wrote to me a few months after the transplant and I wrote back. It is such a sad situation but it was good to hear a bit about the person who made this special gift possible and for me to be able to express my gratitude to their family. Despite everything that has happened to me I feel very lucky.”

Doug Thorburn, divisional director for liver and digestive health at the RFL, said: “The UK liver transplant community collaborated effectively to develop a way to prioritise these patients. This was transformative because there is no other effective treatment available.”

Pictured: Tejwant

Background information:

The ACLF pathway bridges the gap between the chronic liver disease list where patients wait anything from a few days to a year or two and a super urgent list where someone goes into liver

failure from an unknown cause and will automatically go to the top of the transplant list. Historically those on the chronic liver disease list were not able to switch to the super urgent list even if their condition deteriorated rapidly, which is the case with patients who develop ACLF.

Patients on the ACLF list still have to fulfil strict criteria. The patient has to have chronic liver disease and either be on the ICU or high dependency unit with only a 50% chance of surviving for 28 days. The patient’s case is then presented to a panel to make a decision on suitability for transplantation