Details

Autor(en) / Beteiligte

• Vadnerkar, Aniket, MD
• Nguyen, M. Hong, MD
• Mitsani, Dimitra, MD
• Crespo, Maria, MD
• Pilewski, Joseph, MD
• Toyoda, Yoshiya, MD, PhD
• Bermudez, Christian, MD
• Kwak, Eun J., MD
• Silveira, Fernanda P., MD
• Clancy, Cornelius J., MD

Titel

Voriconazole exposure and geographic location are independent risk factors for squamous cell carcinoma of the skin among lung transplant recipients

Ist Teil von

• The Journal of heart and lung transplantation, 2010-11, Vol.29 (11), p.1240-1244

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2010

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Skin cancer, in particular squamous cell carcinoma (SCC), is the most common malignancy after solid-organ transplantation. SCC has been reported in immunosuppressed patients receiving voriconazole, but the agent has not been shown to be a risk factor. Universal voriconazole prophylaxis and alemtuzumab induction are standard in our lung transplant program. Methods We performed a retrospective, case–control study (matched 1:3) among lung transplant recipients at our center from 2003 to 2008. Results SCC was diagnosed in 3.1% (17 of 543) of patients at a median follow-up of 36 months. Median time to development of SCC was 19 months post-transplant. Risk factors for SCC by univariate analysis included older age ( p = 0.02), residence in locations with high levels of sun exposure ( p = 0.0001), single-lung transplant ( p = 0.02) and duration ( p = 0.03) and cumulative dose ( p = 0.03) of voriconazole. Duration of voriconazole (hazard ratio [HR] = 2.1; p = 0.04) and residence in locations with high sun exposure (HR = 3.8; p = 0.0004) were independent risk factors by multivariate analysis. SCC lesions were located on the head and neck in 94% of cases, and 53% had multiple lesions. All patients were treated with surgery. At least one independent lesion developed subsequently in 47% of patients. Local spread and distant metastases each occurred in 7% of cases. There were no deaths among the cases. Conclusions Voriconazole exposure is a risk factor for SCC after lung transplantation, particularly among older patients living in areas with high sun exposure. Voriconazole should be used cautiously in these patients.