A pioneering UK trial is using skin patches from organ donors to help lung transplant recipients detect rejection early.
The SENTINEL trial was set up to investigate whether skin patches can be used as an early warning system to identify if lung transplants are being rejected.
This means treatment can begin sooner, reducing the chance of permanent lung damage.
Lung rejection is difficult to detect and involves frequent hospital visits with invasive blood tests, bronchoscopies, lung biopsies and X-rays.
Rejection rates are highest in the first three to six months after a transplant and involve up to 30% of patients.
Only half of lung transplant patients are still alive after five years, with rejection a significant factor in deaths post-transplant.
Transplanting patches of skin with lung transplants may detect rejection by showing as a rash on the donated skin patch, and may prevent the body from rejecting the lungs. If such a rash is observed, a small skin biopsy will be taken to confirm the presence of rejection.
The skin patch empowers patients to address rejection fears, helping them recognise it and take action.
If the SENTINEL trial is successful and the approach can be rolled out to all lung transplant and heart-lung transplant recipients, the research team believes it could reduce lung rejection.
Patients receive a 10x3cm skin patch from the forearm of their organ donor, which is transplanted onto the patient’s forearm, at the same time as the lung transplant. The skin transplant is carried out by plastic surgeons from the University of Oxford, as well as the lung transplant centres, working alongside the transplant surgeon.
If the skin flap develops a rash, indicating possible rejection, a skin biopsy can be performed instead of an invasive lung biopsy.
In Newcastle, the plastic surgery team has been critical to the running of the trial by both helping with the collection of a skin flap from donors and connecting the skin flap to the patient undergoing a lung transplant.
The team then monitors patients after the skin transplant procedure and performs biopsies when needed.
One of the first lung transplant patients to receive a skin patch from his organ donor in a trial says it has been ‘invaluable’ in identifying rejection before any other symptoms manifest.
Transplant patient Darren White identified a mild rejection episode when his grafted skin patch turned purple, enabling swift steroid treatment and likely preventing severe damage.
Henk Giele, chief investigator of SENTINEL and Oxford plastic surgeon, said: ‘It seems logical that having a window to your transplant can provide an early warning system of rejection or reassure you that you don’t have rejection, but we have to prove it works.
‘We are so grateful to the patients, the donors and their families, the transplant teams, and the NHSBT staff who make this important trial happen. We hope it will change what we know about transplant and make patients’ lives better and longer.’
