AB115. SOH26AB_0453. Sentinel skin flap in liver and pancreas transplantation: patient acceptability of a novel immune surveillance biomarker
General Session II

AB115. SOH26AB_0453. Sentinel skin flap in liver and pancreas transplantation: patient acceptability of a novel immune surveillance biomarker

Omar Quidwai1, Linda Kelly2, Grace Buckley3, Henk Giele4, Roisin Dolan1

1Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland; 2Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; 3Department of Surgery, University College Dublin, Dublin, Ireland; 4Department of Surgery, University of Oxford, Oxford, UK

Background: Rejection monitoring after liver transplantation still relies on blood tests and biopsies, which are invasive and reactive. The sentinel skin flap (SSF), a vascularised donor skin patch on the forearm, offers a visible, biopsy-amenable early warning system for rejection. We aimed to evaluate its acceptability in liver and simultaneous pancreas-kidney (SPK) patients.

Methods: A prospective cross-sectional survey was conducted at a national transplant centre. After a standardised briefing with images and schematics, adult liver and SPK recipients completed a validated questionnaire capturing demographics, transplant history, biopsy experience, and attitudes to SSF, including reassurance, empowerment, cosmetic, and social concerns. Likert, binary, and free-text responses were analysed with thematic analysis and descriptively, and Chi-squared and non-parametric tests explored associations.

Results: A total of 100 liver participants were recruited (51% male; mean age, 52 years). Overall acceptability was high: 89% were likely to undergo SSF if offered, and 77% remained willing even if donor skin tone differed; lower willingness clustered with cosmetic and social stigma concerns. Cosmetic and social concerns were reported by 29% and 19%, respectively. Higher agreement that the SSF empowers patients to be involved in transplant care was found to be negatively associated with cosmetic concern (P=0.05). Willingness to agree to the SSF if the donor skin tone was different to that of their own was strongly associated with reporting cosmetic concern (P=0.01). Thematic analysis highlighted reassurance and early detection in 98% of patients. A smaller parallel SPK cohort of 22 patients showed similar reassurance but higher cosmetic concern.

Conclusions: Across liver and pancreas transplant recipients, SSF was highly acceptable, with strong perceived reassurance and empowerment, and only modest cosmetic or surgical concerns. Subgroup differences highlight the need for tailored counselling. These findings establish patient endorsement and support early-phase clinical trials of SSF monitoring.

Keywords: Liver transplantation; rejection; sentinel skin flap (SSF); patient acceptability; cosmetic concerns

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab115
Cite this abstract as: Quidwai O, Kelly L, Buckley G, Giele H, Dolan R. AB115. SOH26AB_0453. Sentinel skin flap in liver and pancreas transplantation: patient acceptability of a novel immune surveillance biomarker. Mesentery Peritoneum 2026;10:AB115.

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