Transplant success comes with a hidden cost: cancer

Solid organ transplants are saving more lives than ever — U.S. transplant numbers jumped over 50% between 2013 and 2024 — but longer survival is revealing a troubling trade-off. A new study in JAMA Network Open analyzing over 622,000 transplant recipients found that cancer incidence varies significantly by organ type, with lung transplant patients facing the steepest risk across nearly every cancer category.

Compared to kidney transplant recipients, lung recipients were twice as likely to develop solid tumors and nearly three times as likely to develop posttransplant lymphoproliferative disorder (PTLD). Heart and liver recipients also showed elevated rates, though lower than lung patients. Researchers suspect the intensity of immunosuppression — which is highest in lung and heart transplants — may be a key driver, with viral infections (like HPV for genital cancers) potentially playing a role too.

By the Numbers

• 8% of patients were diagnosed with at least one cancer during follow-up
• Lung recipients: solid tumor IRR = 2.01 vs. kidney; PTLD IRR = 2.91
• Nonmelanoma skin cancer IRR for lung recipients rose from 2.01 (year 1) to 4.46 (years 6–10)
• Bladder, colorectal, genital, and lung cancers increased steadily over 10 years
• Lifetime cancer risk in heart transplant patients: ~20%

Why it matters: As transplant survival improves, oncologic vigilance must keep pace. These findings highlight the urgent need for tailored cancer screening protocols and safer immunosuppression regimens for transplant recipients — particularly those with lung or heart transplants.