De novo malignancies after liver transplantation: epidemiology, risk factors, and management strategies

Background. Liver transplantation (LT) significantly improves survival in patients with end-stage liver disease; however, it is associated with an increased risk of developing de novo malignancies. Long-term immunosuppression, viral infections, and unhealthy lifestyle choices increase the risk of post-transplant oncological complications. Objective: to summarize current evidence on the prevalence, risk factors, diagnostic, prevention, and treatment of de novo malignancies in liver transplant recipients. Materials and methods. This paper presents a literature review, including retrospective and prospective studies, meta-analyses, and clinical guidelines published over the past two decades. Results. The most common post-transplant malignancies include non-melanoma skin cancer, lymphoproliferative disorders, and solid organ tumors. Major risk factors are prolonged immunosuppression, viral infections, smoking, alcohol use, advanced recipient age, and the underlying liver disease. Current management strategies involve immunosuppression reduction, surgical resection, chemotherapy, and targeted therapy. In particular, mammalian target of rapamycin (mTOR) inhibitors have demonstrated antitumor efficacy in selected patients, particularly those with Kaposi’s sarcoma and lymphoproliferative disorders. Conclusion. Given the high oncological risk, stratified screening programs and individualized patient management are necessary after LT. Immunosuppression reduction, lifestyle modification, and early detection of malignancies are key factors in improving long-term outcomes.