title: Increased incidence of cutaneous squamous cell carcinoma in lung transplant recipients taking long-term voriconazole.
abstract: BACKGROUND
  Voriconazole has been used for prevention and treatment of fungal infections in patients after lung transplantation. We postulate that long-term use of voriconazole may increase the risk of squamous cell carcinoma of the skin in these patients.
  
  
  METHODS
  The study included 120 patients who received lung transplantation at UC San Diego Health System between July 2000 and June 2006. All patients received a similar initial immunosuppression regimen, and 43 (35.8%) received voriconazole for treatment or prophylaxis for fungal diseases. In this retrospective study, we compared the incidence of squamous cell carcinoma in lung transplant recipients with or without voriconazole use.
  
  
  RESULTS
  Squamous cell carcinomas developed in 39.5% of patients (17 of 43) who received voriconazole for prophylaxis or treatment of fungal disease, compared with 19.5% (15 of 77) who did not receive voriconazole (p = 0.03). Four patients died of metastatic squamous cell carcinoma, all in the voriconazole group. Multiple logistic regression analysis showed older age at the time of transplant (odds ratio [OR], OR (95% CI) 2.8 (1.5-5.5)), skin cancer pre-transplant (OR, 11.0 (1.76-68.4), and longer voriconazole therapy (OR, 1.8 (1.3-2.6)) were independent risk factors for development of skin cancer after transplant.
  
  
  CONCLUSIONS
  Our results suggest that long-term use of voriconazole may be associated with development of cutaneous squamous cell carcinoma in patients after lung transplant. Greater clinical aggressiveness of skin cancer was also noted in these patients.
authors: University of California, San Diego Health System, San Diego, CA, USA.
authors: Ashley
authors: A
authors: Feist
authors: Roy
authors: R
authors: Lee
authors: Stephanie
authors: S
authors: Osborne
authors: James
authors: J
authors: Lane
authors: Gordon
authors: G
authors: Yung
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008172:Lung Diseases, Fungal / Q000517:prevention & control; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D013997:Time Factors; D014180:Transplantation; D014230:Triazoles / Q000009:adverse effects* / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole