Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA.
Dermatol Surg. 2012 Aug;38(8):1369-74. doi: 10.1111/j.1524-4725.2012.02418.x. Epub 2012 May 2.
To determine whether there is an association between duration of voriconazole therapy and number of nonmelanoma skin cancers (NMSC) after lung transplantation.
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.
Academic medical center.
Lung transplant recipients.
Number of NMSC after lung transplantation.
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.
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.
确定伏立康唑治疗时间与肺移植后非黑色素瘤皮肤癌(NMSC)数量之间是否存在关联。
对 1993 年至 2009 年期间在埃默里大学接受肺移植的所有存活患者进行了电话调查和病历回顾。
学术医疗中心。
肺移植受者。
肺移植后 NMSC 的数量。
91 例患者中有 60 例(65.9%)至少在肺移植后接受伏立康唑治疗 3 个月(11.2±8.7 个月,范围 3-58 个月),其中 16 例发生 NMSC,首次发生 NMSC 的平均时间为 38 个月。在未接受伏立康唑治疗的 31 例患者中,有 12 例发生 NMSC,首次发生 NMSC 的平均时间为 52 个月。单变量分析显示,移植后时间(相关系数(r)=0.514)、年龄(r=0.101)和一生中阳光暴露量高(r=0.211)与移植后皮肤癌数量相关。皮肤类型 V 和 VI 具有保护作用(r=-0.353)。多变量回归分析显示,移植后时间(每月 0.061)、年龄(每年 0.151)、皮肤类型 I 或 II(4.939)和伏立康唑暴露时间(0.149)是肺移植后皮肤癌数量的独立危险因素。
伏立康唑暴露时间与肺移植后 NMSC 数量相关。所有接受伏立康唑治疗的患者应了解其皮肤癌风险增加,并应定期进行皮肤科随访以进行皮肤癌筛查。治疗肺移植受者的医生应考虑在有皮肤癌风险的患者中使用伏立康唑的替代药物。