A new ‘skin patch’ trial will investigate if they can be used as an early warning system to identify lung transplant rejection.
This innovative approach could enable prompt treatment, mitigating the risk of lasting damage to the organ.
Early signs of rejection might manifest as a rash on the skin patch, often preceding lung rejection by the body.
Should such signs appear, a skin biopsy will be conducted to confirm rejection.
If successful, this method could potentially reduce rejection rates by up to 50% among lung transplant recipients.
The SENTINEL trial, launched in April, aims to enrol 152 patients over a three-year period for £2 million.
This initiative is spearheaded by the Surgical Intervention Trials Unit (SITU), one of only seven Royal College of Surgeons specialist trial centres in the UK.
SITU operates through a collaboration between the Nuffield Department of Surgical Sciences (NDS) and the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), boasting an extensive portfolio of surgical trials and welcoming interest from potential researchers.
During the lung transplant procedure, patients will receive a 10 x 3cm skin patch from the donor’s forearm, transplanted onto their forearm by a plastic surgeon.
Skin shows signs of rejection earlier than other organs, providing visible cues for timely intervention. Physicians can initiate treatment when a rash appears, potentially preventing lung rejection.
Currently, lung transplant rejection rates remain high, with only around 55% of patients surviving five years post-transplant. Monitoring for rejection involves lung function tests, blood tests, X-rays, and lung biopsies, but early detection remains challenging.
Recognising early indicators of rejection allows for more timely and personalised treatment, prolonging organ function. In the absence of rejection signs, there may be opportunities to reduce immunosuppressant medication, thereby minimising side effects such as increased cancer and diabetes risks.
Chief Investigator Henk Giele, Associate Professor of Plastic, Reconstructive, Transplant and Hand Surgery at Nuffield Department of Surgical Sciences, University of Oxford, said: ‘Lungs are prone to rejection due to their exposure to outside air and high propensity to infection. It is often difficult to know if a reaction is caused by infection or rejection as they look the same at the early stages, but the treatments for each are completely opposite. For this reason, we have focused the SENTINEL trial on the lungs – a visible warning system like this is crucial for all transplants, especially those with higher rejection rates.'
Emma Lawson, Organ Donation Innovation and Research Lead at NHS Blood and Transplant, added: ‘NHS Blood and Transplant is honoured to support the SENTINEL trial by matching suitable patients for the retrieval and transplant and via our specialist nurses in organ donation, who will work with the generous donor families to secure the extra consents needed.
‘Transplants and all of the wonderful benefits they bring are only possible thanks to our fantastic donors. We urge people to register their donation choices on the Organ Donor Register.’
