De Novo Malignancies Post-Liver Transplantation: A Focused Review on Risks, Surveillance and Management

De novo malignancies (DNMs) are new cancers that arise after transplantation and contribute to long-term mortality in liver transplant (LT) recipients, exhibiting 3-14.4-fold higher incidence compared to age- and gender-matched general populations. Established risk factors encompass advanced age, alcohol consumption, tobacco use, viral infections, and prolonged immunosuppressive exposure. Prevention strategies focus on modifiable lifestyle factors, targeted cancer screening, and optimizing immunosuppression. Emerging therapies like mammalian target of rapamycin inhibitors (mTORi) show potential for reducing cancer incidence while maintaining graft function. This comprehensive review synthesizes global epidemiological data on post-LT DNMs, analyzes region-specific risk profiles between Eastern and Western populations, evaluates current management paradigms, and proposes evidence-based surveillance algorithms. In light of the complexity of DNMs between the West and the East, the establishment of consensus guidelines for Asia is critical to support clinical decision-making and enhance patient outcomes.