NHS successfully develops world first national liver transplant priority for patients with high mortality liver disease
People with an often fatal liver condition are for the first time successfully being prioritised transplants thanks to a world-leading NHS change. Details have been published today in the scientific journal, Lancet Regional Health Europe. The life-saving approach is now being considered by other countries across the world.
Acute on chronic liver failure (ACLF) is a serious condition that happens when someone with a long term liver disease suddenly develops organ failure.
Unfortunately, until this new approach, there were very few treatment options for patients with ACLF and 70% of these people, who are often young adults, died within 28 days.
Patients were previously rarely considered for a liver transplant because of how suddenly and quickly people become severely ill. They often quickly became too ill to survive a transplant or died before a suitable donor could be found.
New approach offers hope to patients with ACLF
The new Lancet paper, a service evaluation, 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.
This is the first time critically ill patients with ACLF have been prioritised in a planned national transplant programme. This is also the first time liver transplant has been shown to be a practical and highly effective treatment for selected patients with ACLF when no other treatment option existed.
A service evaluation was launched in 2021 which prioritised ACLF patients immediately after super-urgent patients but before the elective tier and this became standard practice at the end of 2023.
NHS Blood and Transplant introduced the changes following work by the NHS Blood and Transplant Liver Advisory Group and the UK’s seven liver transplant centres. The Lancet paper published today was written by King’s College Hospital and NHSBT with input from all of the seven liver transplant centres.
The results
Of the 52 patients ACLF patients listed for transplant during the pilot phase, 42 received transplants and 77% were alive one year later. By comparison, all 10 of the people who did not receive transplants sadly died within 13 days.
ACLF can affect people of any age but the patient group is younger than average for many illnesses. The people listed for transplant during the evaluation were aged between 39 to 52.
Professor William Bernal of the Liver Intensive Therapy Unit at Kings College Hospital developed the service and worked with other clinicians to deliver the pilot on behalf of the NHS Blood and Transplant Liver Advisory Group. He is the lead author of the Lancet paper. He said:
“As a doctor working in a liver intensive care unit I was used to seeing the devastating impact of this condition. It was truly heartbreaking to see young people come into the unit with multiple organ failure and as a doctor have very few options to keep them alive.
“These patients now have access to a lifesaving therapy for the first time. I feel a sense of pride at seeing the results.
“There is an urgent clinical need for interventions to improve survival for people with this disease, which causes many of the two million deaths from chronic liver disease world-wide each year.”
I was lucky to be alive – without the transplant I would not have made it.
Sunita Mena (married surname Bhuyan), 50, from Colchester, a married mum of two children, suddenly developed primary biliary cholangitis and autoimmune hepatitis, which quickly caused Acute on Chronic Liver Failure within three weeks. She received a lifesaving urgent liver transplant at Addenbrooke's Hospital in Cambridge in 2024.
Sunita said: “Before March, I was leading a healthy and active lifestyle, so the diagnosis came as a tremendous shock.
“My condition deteriorated, I was put into an induced coma and soon after that I had multiple organ failure.
“I was extremely lucky to receive a compatible liver and after a very long and complicated operation that had to be done over two days.
“My first memory after that was waking up in ICU after the transplant – my husband said he’d heard my chances of survival without a transplant were minimal.
“I was lucky to be alive – without the transplant I would not have made it.”
She added: “A simple ‘thank you’ doesn’t suffice for how grateful my family and I are for this gift of life. Recently we celebrated six months since my transplant - six extra months with family and friends. Not a day goes by when I don’t think of the donor and their gift. I am also so grateful to the members of staff at Addenbrookes and I am very happy that people with ACLF can now be prioritised for transplants.
“My recovery is ongoing. I have always loved cooking and baking and I was able to bake a large cheesecake for my friends recently. I can now do regular walks which I absolutely love.”
Tej Sohal
Tej Sohal, aged 43 from Aylesbury, received a lifesaving urgent liver transplant for ACLF at the Royal Free Hospital in London during the pilot period in October 2021.
He had been diagnosed with cryptogenic cirrhosis (liver failure from an unknown cause) a few weeks earlier, which then led to Acute on Chronic Liver Failure.
Tej said: “When I woke up after surgery I had no idea I had already received a transplant. I realised I had lost about two weeks whilst I was induced. I was fortunate enough to receive a donor organ at the right time and make a very good recovery.
“I was able to go back to work a few months after surgery and have continued to maintain a healthy active life and enjoy a full quality of life with my family. I will forever be grateful to the doctors and nurses who cared for me during those weeks and for having a donor in a relatively short period of time.”