Duration of Voriconazole Exposure: An Independent Risk Factor for Skin Cancer After Lung Transplantation

Objective To determine whether there is an association between duration of voriconazole therapy and number of nonmelanoma skin cancers (NMSC) after lung transplantation. Design A telephone-based survey and chart review were performed for all living patients who received a lung transplant at Emory University from 1993 to 2009. Setting Academic medical center. Participants Lung transplant recipients. Main Outcome Measured Number of NMSC after lung transplantation. Results Sixty of 91 (65.9%) subjects were exposed to voriconazole for at least 3 months (11.2 ± 8.7 months, range 3–58 months) after lung transplantation, of whom 16 developed NMSC, with a mean of 38 months to first NMSC. Of 31 patients not exposed to voriconazole, 12 developed NMSC, with a mean of 52 months to first NMSC . By univariate analysis, time since transplant (correlation coefficient (r) = 0.514), age (r = 0.101), and high lifetime sun exposure (r = 0.211) were correlated with number of skin cancers after transplantation. Skin types V and VI were protective (r = −0.353). In multivariate regression, time since transplantation (0.061 per month), age (0.151 per year), skin type I or II (4.939), and months of exposure to voriconazole (0.149) were found to be independent risk factors for number of skin cancers after lung transplantation. Conclusion Duration of voriconazole exposure correlates with number of NMSC after lung transplantation. All patients exposed to voriconazole should be educated about their increased risk of skin cancer and should have regular dermatologic follow-up for skin cancer screening. Physicians caring for lung-transplant recipients should consider alternatives to voriconazole in patients at risk for skin cancer