“Skin patch turning purple helped me spot lung rejection” says transplant patient in pioneering trial

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.

The SENTINEL trial was set up to investigate if 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 occurs when the transplanted organ is attacked by the immune system. 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 3 to 6 months after a transplant and involve up to 30% of patients.

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 rejecting the lungs. If such a rash is seen, a small biopsy from the skin will be taken, as a step to confirm the presence of rejection.

Only half of lung transplant patients are still alive after 5 years, with rejection a significant factor in deaths post transplant (1).

Darren's story

Darren White, 53, dad to Daniel, aged 3, was one of the first patients in the UK to receive a skin patch as a part of the SENTINEL trial and believes it has been critical in identifying early rejection of his transplanted organ after his patch developed a purple rash.

He was under the care of the University Hospital of North Tees then referred to Newcastle's Freeman Hospital. The former bus driver received his lung transplant there in late 2024, after being diagnosed with lung fibrosis (2), at the start of the year.

"I started to feel more and more breathless, I had to sit down for 5 minutes after going up the stairs of my bus. I sought medical attention and was sent directly to the hospital. Never did I think that I would get the diagnoses that I did and that I would need a lung transplant”, says Darren.

After 2 months on the waiting list, Darren, who is married to Karen, aged 50, received the call to say a donor had been found. He had been approached about being a part of the SENTINEL trial, which started in 2024, while he was waiting. He received a patch of skin from his donor, transplanted on to his forearm.

"I didn't hesitate to say yes. Anything that might help to avoid rejection was worth a try. Rejection is the biggest fear of any transplant recipient, so having something that might be able to catch it much sooner than otherwise, was really appealing."

3 months after transplant, Darren, from Stockton-on-Tees, noticed a purple rash on the skin patch and sent photos to his medical team.

Donor skin patch showing rash on transplant recipient's arm He went into his transplant centre for a skin biopsy and results showed very mild rejection, which was treated with steroids. The skin patch empowers patients around rejection fears, allowing them to look out for it and actively take action. Darren responded to treatment and is now doing well.

"I definitely believe the skin patch helped to stop the lungs from being rejected. I was feeling fine, there was no reason for me to think that the lungs were being rejected, the only sign was the rash.

"I'm over a year post-transplant now and doing really well. Who knows if that would be the case if the rash hadn't shown up and rejection wasn't spotted until further down the line.

"The trial is a truly fantastic thing and I hope it goes on to show that a skin patch is a viable option for identifying rejection as early as possible. If anybody in my position is approached about the possibility of receiving a skin patch, I’d say absolutely join the trial. Don’t hesitate, just do it.

"The trial is brilliant, it’s helping me looking after myself and it’s given me peace of mind because you can check your skin."

"I'm eternally grateful to the trial team but most of all, to my donor's family, who made the selfless and incredibly generous decision to allow donation to go ahead, but to also agree to this extra donation, of the skin patch. I hope they know how important both of those decisions were to me and how I thank them every day. Thank you, thank you without end."

Speaking about the overall difference his lung transplant has made, Darren says: "The biggest difference is I can walk, I can take Daniel to the park to play. Before he could sit on my knee, drive my buggy but that was it, I couldn't do much with him. I can be more of a dad now.

"My favourite thing is to go to the park, Daniel always asks to go on the swing and we have one in our garden. I can push him now. It’s the simple things that are the best, we both love it."

About the SENTINEL trial

The £2 million SENTINEL trial is run by the Surgical Intervention Trials Unit as part of the Nuffield Department of Surgical Sciences and sponsored by the University of Oxford in collaboration with NHS Blood and Transplant and the 5 UK cardiothoracic transplant centres (3). It is funded by a UKRI Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) partnership.

If the SENTINEL trial is a success and the approach can be rolled out to all lung transplant and heart and lung transplant recipients, the research team believe it could cut lung rejection.

If the skin flap produces a rash and therefore indicates possible rejection, a skin biopsy can be taken instead of an invasive lung biopsy, which is better for patients as the skin test is less invasive.

The trial is set to run until 2027 and will recruit a total of 152 patients. To date, 39 patients have been recruited to the trial and ten patients have received a skin patch.

Patients receive a 10 x 3cm 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 a plastic surgeons from the University of Oxford as well as the lung transplant centres, working alongside the transplant surgeon.

Skin seems to reject earlier than other organs and is easily visible at all times. This means doctors can treat the rejection as soon as a skin rash appears, to try to prevent the lung from also rejecting.

The transplants are carried out by the lung transplant teams at specialist cardiothoracic centres across England. Donor families need to give consent for the skin transplant to take place, which will be requested by NHS Blood and Transplant specialist nurses.

Sentinel skin grafts have previously been used in studies where patients received intestinal transplants. It was observed that patients who received a skin patch experienced a much lower rate of organ rejection – around half of what would be expected, suggesting that the patch helped to prevent rejection as well as being a useful monitor of early rejection.

Statements

Statement from Henk Giele

Henk Giele, chief investigator of SENTINEL and Oxford plastic surgeon, says:

"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 makes patients lives better and longer."

Statement from Aimee Hennessy

Aimee Hennessy, SENTINEL Trial Coordinator at the Surgical Intervention Trials Unit as part of the Nuffield Department of Surgical Sciences and sponsored by the University of Oxford, says:

"The use of a skin flap represents a bold step toward redefining what is possible in transplant medicine and patient care. The trial reflects our belief that every advancement in research brings us closer to a future where patients have more options, more hope, and better outcomes."

Statement from Emma Lawson

Emma Lawson, Organ Donation Innovation and Research Lead at NHS Blood and Transplant, adds:

"Thanks to the generosity of amazing donor families providing additional consent for skin grafts, patients are now receiving them and we are privileged to work alongside them to enable this important trial to go ahead. Our specialist nurses in organ donation are supporting families at every step and we continue to match suitable patients for retrieval and transplant."

Statement from Andrew Fisher

Andrew Fisher, Professor of Respiratory Transplant Medicine at Newcastle University, Honorary Consultant Respiratory Physician at Newcastle Hospitals and the lead for SENTINEL in Newcastle, says:

"It's exciting to see patients taking part in the SENTINEL skin patch trial. If successful, this approach has the potential to revolutionise the way lung transplants are performed in the future and reduce the problems with detecting and treating rejection early, which is vital.”

Statement from Laura Gornicki

Laura Gornicki, Lead Nurse for SENTINEL at Harefield Hospital, one of the 5 UK transplant centres recruiting patients, says:

"Transplants transform lives but they can be really vulnerable to complications like rejection. So it is brilliant to see this trial working well and there is huge potential for transplant patients, their families and all those involved in their care. If we’re able to see signs of rejection in advance we can provide more effective treatment to try to prevent it."

Statement from Professor John Simpson

Professor John Simpson, Director of the MRC-NIHR EME Programme, said:

"NIHR marks its 20th anniversary this year and during that time, we've funded research into a wide range of cutting-edge studies like SENTINEL, assessing innovative new treatments which can help people live healthier lives for longer. Research to identify life-changing treatments starts with people like Darren, and with the family of his organ donor. Without his participation, or that of the families who generously donated these additional skin grafts, we couldn't run this crucial trial.

"Stories like Darren's have driven the NIHR's mission over the past two decades, and they remain the reason we continue to fund and deliver research that changes lives today. We encourage everyone - no matter their current state of health - to take part in research by signing up to the NIHR's free Be Part of Research service."

Find out more

To find out more about organ donation, and confirm your support for organ donation, visit our website, call 0300 123 23 23 or use the NHS app.

For more information on the SENTINEL skin trial, visit the study website and trial registration.

To find out more about taking part in research, and to find studies that are relevant to you, visit the NIHR's Be Part of Research website.

Press release notes

The national rate of patient survival following an adult lung transplant is 54.8% at five years (NHSBT Annual Report On Lung Transplantation 2015-2025 pg 50)
Lung fibrosis is where lungs become scarred, impacting breathing
Freeman Hospital - Newcastle, Harefield Hospital – Harefield, Queen Elizabeth Hospital – Birmingham, Royal Papworth Hospital – Cambridge, Wythenshawe Hospital – Manchester