Management of de novo malignancies after liver transplantation

Due to advances in medical and surgical expertise leading to significant improvements in graft and patient survival, there is an increased recognition of long term complications in survivors such as de novo malignancies, cardiovascular events and infections. Data show solid organ transplant recipients have 2-3 times the increased risk of developing a de novo malignancy compared to an age-matched and sex-matched general population and malignancy is expected to be the number one cause of mortality in long term transplant recipients in the next two decades. Risk factors include an aging transplant population, oncogenic viruses and the long term effects of immunosuppression in the development of carcinogenesis. This review summarizes common de novo malignancies occurring in the post liver transplant population and current strategies for their prevention and management. Unfortunately, due to limited evidence based data, robust screening guidelines for post transplant cancer prevention have yet to be implemented in this population.