Lung transplant patients to trial ‘early-warning’ skin patches

Lung transplant patients are to be given “skin patches” from their donor in the hope it could cut organ rejection rates by half.

The trial by Oxford University and NHS Blood and Transplant will investigate whether the patches can be used as an “early warning system” to identify lung rejection.

Experts said that skin rejects earlier than other organs and can be easily seen.

Rejection may show as a rash on the donated skin patch, often before the body has started to reject the lungs. If such a rash is noticed, a tiny biopsy from the skin will be taken, as a step to confirm the presence of rejection.

If the trial is a success, experts believe it could reduce rejection rates by up to 50 per cent.

Spotting problems early means medics can give personalised preventive treatment.

Immunosuppressants are currently given to all patients after a transplant to dampen down the body’s immune system to stop it attacking the “foreign” organ.

Reducing the risk

The skin patches could mean that such medications can be reduced in patients who are doing well – reducing the risk of other major risks including cancer.

Under the research, which has just started, more than 150 patients will be recruited to the £2 million Sentinel trial over three years.

About 100 lung transplants are carried out in the UK annually, but rejection rates are high – between 20 and 30 per cent in the first year.

Within five years of such transplant, about 55 per cent of patients are alive.

Currently, rejection is monitored through tests of lung function, blood tests, X-rays and lung biopsies. However, using these methods it is difficult to identify rejection until it is quite advanced.

The study follows success in a similar trial for patients who received intestinal transplants. Researchers found that skin displayed a visible rash between one and 10 days before the transplant was rejected.

Lower rate of rejection

Those given skin flaps which were tracked had a far lower rate of organ rejection.

The latest trial is being run by the surgical trials unit at Oxford University in collaboration with NHS Blood and Transplant.

The transplants will be carried out by the lung transplants teams at specialist cardiothoracic centres across England.

Patients involved in the trial will receive a skin patch from the forearm of the organ donor, measuring at 10cm (about 4in) by 3cm, which will be transplanted onto the under-surface of the patient’s forearm by a plastic surgeon at the same time as the lung transplant.

Adam Alderson, 44, from Wensleydale, received a skin graft as a part of a multi-organ transplant in 2015, which helped identify signs of rejection.

‘Biggest fears’

“Rejection is one of an organ recipient’s biggest fears,” he said.

“Being able to quickly and easily identify if any rejection is occurring is an incredible thing to be able to do, so if the trial is successful and it can potentially work for a large number of transplant recipients, it could be groundbreaking.

“My abdominal wall graft has shown rejection three times, allowing it to be quickly treated.

“It’s a really comforting thing to have – I feel safer knowing that I have a tool available to tell if something is going wrong before it becomes too serious. It’s almost like an oil warning light on your car.”

Helen Roper, 43, from Oxford, has cystic fibrosis, has previously been on the transplant list and faces a potential lung transplant.

She said: “As somebody who faces the very real prospect of a possible lung transplant in my future, the idea that I could potentially be able to identify any rejection early, just by looking at a patch of skin on my arm, is extremely encouraging and helps to alleviate some fears. “The Sentinel trial could be a huge development for future lung transplant recipients and I look forward to hearing the outcome of the study.”

‘Peace of mind’

Fiona Ballantyne is on the waiting list for a lung transplant after being diagnosed with pulmonary arterial hypertension in 2019.

The 56-year-old, from Camelon, Falkirk, applied to join the trial and said that if it is a success it would be a “momentous moment for transplant recipients”.

She added: “The opportunity to potentially be able to see if your organ is rejecting just by looking at your arm is huge for those of us who are facing transplants.

“Not only because of the fact we could receive treatment earlier than if we didn’t have the patch, but also for the peace of mind it would offer, being able to consult the skin patch whenever we feel under the weather.”

Henk Giele, chief investigator and associate professor of plastic, reconstructive, transplant and hand surgery at University of Oxford, said: “Lungs are prone to rejection because of 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.

“It’s for this reason that we have focused the Sentinel trial on the lungs – a visible warning system like this is crucial for all transplants, but especially those with higher rejection rates.”

‘Minimise side effects’

Andrea Leadsom, the health minister, said: “This trial offers hope to lung transplant patients across the country. Early detection of organ rejection means a healthier transplant, giving people greater control of their care and speeding up access to treatment.

“We are committed to funding innovative research like this through the National Institute for Health and Care Research, which will help us revolutionise transplants, minimise side effects, and ultimately save lives.”

Emma Lawson, research lead at NHS Blood and Transplant, said the organisation was honoured to support the 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”.

The study is being funded by a Medical Research Council and National Institute for Health and Care Research partnership.