Open AccessVoriconazole increases the risk for cutaneous squamous cell carcinoma after lung transplantation
Author(s) -
Kolaitis Nicholas A.,
Duffy Erin,
Zhang Alice,
Lo Michelle,
Barba David T.,
Chen Meng,
Soriano Teresa,
Hu Jenny,
Nabili Vishad,
Saggar Rajeev,
Sayah David M.,
DerHovanessian Ariss,
Shino Michael Y.,
Lynch Joseph P.,
Kubak Bernie M.,
Ardehali Abbas,
Ross David J.,
Belperio John A.,
Elashoff David,
Saggar Rajan,
Weigt S. Samuel
Publication year - 2017
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12865
Subject(s) - voriconazole , medicine , risk factor , cohort , lung transplantation , transplantation , population , proportional hazards model , oncology , antifungal , dermatology , environmental health
Summary Lung transplant recipients ( LTR ) are at high risk of cutaneous squamous cell carcinoma ( SCC ). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC . We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post‐transplant. Using Cox proportional hazards models, time to SCC was compared between targeted ( N = 199) and universal ( N = 201) prophylaxis cohorts. Cox models were also used to assess SCC risk as a function of time‐dependent cumulative exposure to voriconazole and other antifungal agents. The risk of SCC was greater in the universal prophylaxis cohort ( HR 2.02, P < 0.01). Voriconazole exposure was greater in the universal prophylaxis cohort, and the cumulative exposure to voriconazole was associated with SCC ( HR 1.75, P < 0.01), even after adjustment for other important SCC risk factors. Voriconazole did not increase the risk of advanced tumors. Exposure to other antifungal agents was not associated with SCC . Voriconazole should be used cautiously in this population.