Singh A, Singh C, Dhaliwal A, Singh N, Kumar V, Sohal A, Schneider J. Incidence, screening, and management of de novo malignancies in liver transplant patients: A review. World J Transplant 2025; 15(3): 101046 [DOI: 10.5500/wjt.v15.i3.101046]
Corresponding Author of This Article
Aalam Sohal, Academic Fellow, Division of Gastroenterology, Creighton University School of Medicine, 3216 NE 45th Pl Suite 212, Phoenix, AZ 85012, United States. aalamsohal@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 101046 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.101046
Incidence, screening, and management of de novo malignancies in liver transplant patients: A review
Anmol Singh, Carol Singh, Armaan Dhaliwal, Navdeep Singh, Vikash Kumar, Aalam Sohal, Jonathan Schneider
Anmol Singh, Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
Carol Singh, Department of Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Armaan Dhaliwal, Division of Hematology and Oncology, Lehigh Valley Health Network, Allentown, PA 18103, United States
Navdeep Singh, Department of Medicine, Government Medical College, Amritsar 143001, Punjab, India
Vikash Kumar, Aalam Sohal, Division of Gastroenterology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
Jonathan Schneider, Division of Gastroenterology, Tristar Centennial Medical Center, Nashville, TN 37203, United States
Author contributions: Singh A and Sohal A conceptualized and designed the study; Singh A, Singh C, Dhaliwal A and Singh N conducted the literature review, interpreted data, created artwork, and drafted the original manuscript; Kumar V, Singh A, Sohal A and Schneider J supervised the study and made critical revisions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aalam Sohal, Academic Fellow, Division of Gastroenterology, Creighton University School of Medicine, 3216 NE 45th Pl Suite 212, Phoenix, AZ 85012, United States. aalamsohal@gmail.com
Received: September 3, 2024 Revised: January 29, 2025 Accepted: February 27, 2025 Published online: September 18, 2025 Processing time: 227 Days and 8 Hours
Abstract
Liver transplantation (LT) is the definitive treatment for end-stage liver disease, acute liver failure, and liver cancer. Although advancements in surgical techniques, postoperative care, and immunosuppressive therapies have significantly improved outcomes, the long-term use of immunosuppression has increased the risk of complications, including infections, cardiovascular disease, and cancer. Among these, de novo malignancies (DNMs) are a major concern, accounting for 20%-25% of deaths in LT recipients surviving beyond the early post-transplant period. Non-melanoma skin cancers, particularly squamous cell carcinoma are the most prevalent DNMs. Other significant malignancies include Kaposi's sarcoma, post-transplant lymphoproliferative disorders, and various solid organ cancers, including head and neck cancers. Compared to the general population, LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders. Risk factors for DNM include chronic immunosuppression, alcohol or tobacco use, viral infections, and underlying liver disease. Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies, including regular dermatological examinations, targeted screenings for high-risk cancers, and patient education on lifestyle modifications. Early detection through enhanced surveillance protocols has been shown to improve outcomes. Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens, with promising results from the use of mTOR inhibitors in select patients. The review highlights the critical need for ongoing research to refine risk stratification, optimize screening protocols, and improve treatment approaches to mitigate the burden of DNMs in LT recipients. By implementing personalized preventive and therapeutic strategies, we can enhance long-term outcomes and quality of life for this vulnerable population.
Core Tip: Liver transplantation (LT) is crucial for treating severe liver conditions, but it increases the risk of new cancers, especially non-melanoma skin cancers like squamous cell carcinoma. LT recipients also have a higher chance of developing solid organ cancers and lymphoproliferative disorders compared to the general population. Key risk factors include chronic immunosuppression, alcohol or tobacco use, and viral infections. Effective management involves regular cancer screenings, early detection, and adjusting immunosuppressive treatments, particularly for Kaposi's sarcoma and post-transplant lymphoproliferative disorders.
