Factors associated with skin cancer in lung transplant recipients: A single-center experience

Abstract

Background: Skin cancer is common after solid organ transplantation, but few have investigated it after lung transplant (LTx).

Objective: We assessed incidence and predictors of non-melanoma skin cancer (NMSC) post-LTx.

Methods: We studied patients who underwent LTx at our center from 2012 to 2015.

Results: Of 287 patients, mean age was 59.6 ± 11 years, 170 (59.2%) were men, and 231 (80.5%) were white. Seventy-six (26.5%) developed NMSC over a median follow-up of 32 months (IQR, 23-45). Of those with NMSC, 37% developed subsequent skin cancer of the same type. Independent predictors of decreased odds of NMSC and squamous cell carcinoma (SCC) were non-white race (P = .002; P = .003) and body mass index >30 kg/m² compared with underweight patients (P = .001, P = .009). Patients with skin cancer pre-LTx had higher risk of post-LTx skin cancer (P = .02). Voriconazole use ≥100 days was associated with increased risk of SCC (P = .03), but not increased risk of basal cell carcinoma. Out of 76, 4 (5.3%) died from skin cancer.

Limitations: Retrospective, single-center study.

Conclusion: Squamous cell carcinoma risk post-LTx may increase with prolonged voriconazole use in white patients with pre-LTx history of skin cancer, whereas excess body weight may be protective from NMSC. Regular pre- and post-LTx skin cancer screenings and guidelines are warranted.

Keywords: basal cell carcinoma; immunosuppression; lung transplant; skin cancer; squamous cell carcinoma.