Frontiers in transplantation最新文献

{"title":"Smartphone-measured tremor and tacrolimus trough levels in kidney transplant recipients: an exploratory prospective study.","authors":"Annudesh Liyanage, Caitlin Schneider, Julien Renard, Rohit Singla, Jorden Hetherington, Steven Tang, Ted Hoyda, James Lan, Cindy Luo, David Harriman, Christopher Nguan","doi":"10.3389/frtra.2026.1870210","DOIUrl":"10.3389/frtra.2026.1870210","url":null,"abstract":"<p><p>Tacrolimus commonly causes tremor as a side effect, although the relationship between tremor and tacrolimus drug levels is not well established. This work presents the development of a smartphone-based tremor assessment to explore whether tremor features are associated with tacrolimus trough concentrations, including whether individualized models show promise in tremor-sensitive kidney transplant patients. Using smartphone accelerometers, an app was created to record resting and postural tremors in transplant recipients during routine follow-up visits. Tacrolimus trough concentration and doses were recorded at each visit. We evaluated associations between tremor features and tacrolimus trough levels and, in exploratory analyses, assessed regression models both at the cohort level and within individuals with sufficient longitudinal data. Sixty-nine kidney transplant recipients were included. Correlations were found between self-reported tremor severity and tremor features, but no significant association was observed between tacrolimus trough concentration and tremor features at the cohort level (<i>ρ</i> = 0.022, <i>p</i> = 0.447). Population-level regression models showed poor predictive performance. <i>post-hoc</i> exploratory individualized models among patients with adequate longitudinal data (<i>n</i> = 8) provided an averaged root mean squared error of 2.33 ± 1.42 µg/L; three patients achieved root mean squared errors below 1.3 µg/L. Smartphone tremor features did not support population-level prediction of tacrolimus trough concentrations in kidney transplant recipients. Exploratory individualized regression models yielded potentially useful performance in a small subset; consistent with heterogeneity in tacrolimus tremor severity. These findings are hypothesis-generating; larger prospective studies should focus on identifying and validating tremor-sensitive patients for individualized approaches.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1870210"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-transplant lymphoproliferative disorder after solid organ transplantation: a comprehensive review.","authors":"Lina Patricia Vargas-Nieto, Nicolás David Santoyo-Sarmiento, Maria Ballesteros-García, Angie Tatiana Calderón-Vásquez, Álvaro Daniel Pinto-Rodriguez, Maria Gabriela Robayo-Romero, Valeria Cormane-Alfaro, Jorge Daza-Buitrago","doi":"10.3389/frtra.2026.1869288","DOIUrl":"10.3389/frtra.2026.1869288","url":null,"abstract":"<p><p>Post-transplant lymphoproliferative disorder (PTLD) is a serious and heterogeneous neoplastic complication of solid organ transplantation (SOT), arising in the setting of sustained pharmacological immunosuppression. This review is specifically focused on PTLD in the SOT setting; PTLD after hematopoietic stem cell transplantation (HSCT) differs substantially in risk factors, pathogenesis, and management, and is beyond the scope of this work. PTLD incidence ranges from 1% to 20%, depending on the grafted organ, with the highest per-procedure rates in intestinal and multiorgan transplants, and the highest absolute case burden in kidney recipients, given transplant volume. PTLD demonstrates a bimodal temporal distribution: an early, predominantly EBV-driven peak at 12-24 months post-transplant, and a late peak at 5-10 years, with a higher proportion of EBV-negative cases. Contemporary evidence suggests a possible decline in early EBV-positive PTLD with improved surveillance, while late-onset EBV-negative PTLD is stable or increasing. EBV establishes latency type III in PTLD-associated B cells, driving proliferation through viral oncoproteins LMP1 and EBNA2. The latency program correlates with histological category and clinical behavior: latency III predominates in early lesions and polymorphic PTLD with strong EBER expression, whereas EBV-negative monomorphic PTLD displays greater genomic complexity, resembling <i>de novo</i>diffuse large B-cell lymphoma (DLBCL), with frequent TP53 mutations and chromosomal gains. The WHO 2022 and ICC 2022 frameworks define four histopathological categories-non-destructive lesions, polymorphic PTLD, monomorphic PTLD, and classic Hodgkin lymphoma (CHL)-type PTLD-each with distinct morphological, immunophenotypic, EBER, and clonality profiles that directly determine treatment intensity. Management follows a sequential strategy: immunosuppression reduction (ISR) as the mainstay first step, followed by rituximab, then chemoimmunotherapy (R-CHOP) for refractory or high-risk disease, with PET/CT-based response assessment using Lugano criteria at each decision point. Tabelecleucel, an allogeneic EBV-specific cytotoxic T-lymphocyte (CTL) product, represents the first approved cellular therapy for refractory EBV-positive PTLD. Immune checkpoint inhibitors carry unacceptably high organ rejection rates and are not recommended for standard PTLD management. Key unmet needs include standardizing EBV surveillance thresholds for preemptive intervention, biomarker-driven risk stratification (PD-L1, LMP1, tumor EBV viral load), and prospective multicenter data on novel immunotherapy combinations in immunosuppressed transplant recipients.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1869288"},"PeriodicalIF":0.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal transplantation and variations in blood supply: a narrative review.","authors":"Spencer Thrailkill, Abduelmenem Alashkham, Mohamed Elajnaf, Tarek Almabrouk","doi":"10.3389/frtra.2026.1843066","DOIUrl":"10.3389/frtra.2026.1843066","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) has become a significant global health challenge as patients frequently progress to end-stage renal disease leading to kidney transplantation. Anatomical variations of the renal vascular structure may affect donor candidates, surgical management, and graft success, making it important to consider in transplantation. Although the use of anatomically complicated grafts is growing, differences in vascular pattern continue to impact clinical decision-making.</p><p><strong>Objective: </strong>To investigate the anatomical features of the renal vasculature and determine its clinical significance for kidney transplantation and their effect on surgical complexity and transplant outcomes.</p><p><strong>Methods: </strong>Narrative literature review was performed through PubMed, Scopus and Google Scholar. Articles were included if they were related to kidney vascular anatomy, imaging evaluation, surgical methods, and transplant results. Literature: Included in this review were historical and relevant secondary studies to offer a global perspective of the latest developments in renal transplantation practice.</p><p><strong>Results: </strong>A large body of studies have explored these renal vascular variations with up to 30% of people having at least two renal arteries, and venous variations such as retroaortic or circumaortic renal veins. These variations can lead to a more complex surgery and duration of operation, as well as a higher chance of development of early complications (delayed graft function or vascular thrombosis) due to ischemia-induced complications. Yet evidence is currently accumulating that, with sound preoperative imaging and surgical precision, the long-term prognosis of grafts and patient outcomes is similar to that of standard vascular anatomy graft. Developments in imaging modalities, especially computed tomography angiography, have greatly advanced both preoperative detection and surgical planning.</p><p><strong>Conclusion: </strong>Such renal vascular variations should not automatically preclude transplantation and should not be considered as an adverse event when donating or transplanting kidneys. Anatomically complex grafts can be successfully used, with careful preoperative assessment, multidisciplinary planning and modern surgical techniques. More standardized reporting and more recent studies are required to optimise donor utilisation and thereby optimize transplant success.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1843066"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of immunosuppressive therapy in the context of uterine VCA and pregnancy.","authors":"Andrew D'Elia, Kevin Ghajar, Kevin J Zuo","doi":"10.3389/frtra.2026.1825928","DOIUrl":"10.3389/frtra.2026.1825928","url":null,"abstract":"<p><p>Uterine vascularized composite allotransplantation (VCA) represents one of the latest developments in the field of transplant surgery and treatment of uterine-factor infertility. Unlike other forms of VCA, uterine transplantation involves a temporary allograft, pregnancy-associated physiologic and pharmacokinetic changes, and complex maternal-fetal immunologic interactions, creating distinct challenges in immunosuppression management. Herein, we perform a comprehensive review of the latest and relevant literature on immunosuppressive strategies in the context of VCA and pregnancy, with particular emphasis on their relevance to uterine VCA. Evidence from solid organ transplantation, autoimmune disease, and reported uterine transplant protocols was synthesized to inform stage-specific management strategies. Available data support corticosteroids, calcineurin inhibitors, azathioprine, and hydroxychloroquine as pregnancy-compatible agents, whereas mycophenolate mofetil, methotrexate, and cyclophosphamide remain contraindicated due to teratogenicity. Pregnancy-related pharmacokinetic and pharmacodynamic changes significantly influence drug exposure and necessitate individualized dosing and close therapeutic monitoring. Emerging evidence suggests that pregnancy-associated immune modulation, including regulatory T-cell expansion and microchimerism, may reduce rejection risk, although this remains incompletely characterized. Based on best available evidence, we present a summary for immunosuppressive management spanning induction, preconception optimization, pregnancy, delivery, and postpartum graft removal. Future priorities include development of noninvasive rejection monitoring, precision pharmacokinetic modeling, and tolerance-inducing strategies to improve maternal, fetal, and allograft outcomes in uterine transplantation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1825928"},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematocrit-adjusted tacrolimus levels are associated with acute kidney injury but not rejection early after liver transplantation.","authors":"Trana Hussaini, Daljeet Chahal, Vladimir Marquez, Tianyi Wen, Monica Dahiya, Eric M Yoshida, Michael R Law","doi":"10.3389/frtra.2026.1878595","DOIUrl":"10.3389/frtra.2026.1878595","url":null,"abstract":"<p><strong>Introduction: </strong>Tacrolimus (Tac) is highly bound to erythrocytes, with less than 1% present in the pharmacologically active unbound fraction. In anemia, whole-blood trough concentrations may underestimate effective exposure. Hematocrit (Hct) adjustment has been proposed but clinical outcome data are limited.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of adult liver transplant recipients (2018 to 2022) to examine the relationship between Hct-adjusted Tac and early clinical outcomes. Tac troughs, Hct, and serum creatinine were collected for 90 days. Hct-adjusted Tac was calculated as (0.45 ÷ Hct) × total Tac. The difference between adjusted and measured Tac (delta Tac) was used to represent anemia-related underestimation and modeled as a time-varying covariate in Cox regression for acute kidney injury (AKI) and biopsy-proven T cell-mediated rejection (TCMR), adjusting for established risk factors.</p><p><strong>Results: </strong>Among 344 recipients (median age 59 years; 62% male), TCMR occurred in 15.7% and AKI in 69.8%. Delta Tac was not associated with TCMR (HR 0.93, 95% CI 0.77 to 1.14) but was associated with higher AKI hazard (HR 1.15 per ng/mL, 95% CI 1.08 to 1.24).</p><p><strong>Discussion: </strong>These findings suggest that divergence between Hct-adjusted and measured Tac is associated with increased AKI risk without a corresponding signal for rejection.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1878595"},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary strategies for donor heart preservation in heart transplantation.","authors":"Joseph Israeli, Steven Pham, Jennie Ngai","doi":"10.3389/frtra.2026.1825471","DOIUrl":"10.3389/frtra.2026.1825471","url":null,"abstract":"<p><p>Heart transplantation outcomes have tremendously improved over the nearly fifty years that the procedure has been performed. As demand continues to grow, there is a persistent shortage of organs. Compounding this is the potential for organs to deteriorate with increasing preservation and transport times. New technologies have been developed to address these issues. These include novel physiologic preservation solutions and preservation devices (which range from those that optimize temperature control to those that use machine perfusion or combinations of these facets) to minimize the risk of ischemic injury. Research is ongoing into these techniques and their potential to improve outcomes by protecting donor organs (particularly in cases of prolonged ischemic times) and expand the donor pool by better preserving grafts from marginal and/or donation after circulatory death donors. There is even research into utilizing these technologies to enable safe cardiac xenograft implantation as well as their role in beating heart transplantation.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1825471"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Third annual transplant AI symposium: from organ matching to digital twins.","authors":"Devina Ramesh, Praveen Manickavel, Aman Sidhu, Walter K Kremers, Girish Mour, Robert C Huebert, Joseph Ahn, Mamatha Bhat","doi":"10.3389/frtra.2026.1871888","DOIUrl":"10.3389/frtra.2026.1871888","url":null,"abstract":"<p><p>The Ajmera Transplant Center and Mayo Clinic hosted the third annual Transplant Artificial Intelligence (AI) Symposium in Toronto, Canada, bringing together expert clinicians, researchers, scientists, and trainees to discuss the current role of AI in transplant medicine. This paper summarizes the third annual Transplant AI Symposium proceedings and talks. Presentations covered a wide range of topics across the transplant continuum, highlighting numerous benefits of AI in transplantation such as organ matching, human-AI collaboration, and survival/risk prediction. Artificial intelligence is most useful when linked to specific clinical problems, especially those involving multimodal or longitudinal data. However, speakers also emphasized ongoing limitations in data quality, generalizability, workflow integration, and fairness. Multiple presentations highlighted the importance of clinician oversight. Overall, the symposium highlighted that the future of transplant AI will depend on careful validation, clinically meaningful implementation, and attention to patient outcomes (Figure 1).</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1871888"},"PeriodicalIF":0.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic priming of liver regeneration: from mechanisms to <i>ex vivo</i> machine perfusion.","authors":"Sarah Yoshimi Tropp, Dinesh Jaishankar, Carl Atkinson, Satish N Nadig","doi":"10.3389/frtra.2026.1841091","DOIUrl":"10.3389/frtra.2026.1841091","url":null,"abstract":"<p><p>The liver's extraordinary regenerative capacity has fascinated biologists for decades, yet the translation of regenerative biology into clinically effective therapies remains limited. Regeneration is not a simple proliferative response but a tightly orchestrated program initiated by tissue injury and coordinated through inflammatory priming, complement activation, mechanosensory signaling, extracellular matrix remodeling, metabolic reprogramming, and growth factor-driven hepatocyte proliferation. In this review, we synthesize current understanding of the cellular and molecular networks that govern liver regeneration, emphasizing the dynamic crosstalk among hepatocytes, Kupffer cells, liver sinusoidal endothelial cells, hepatic stellate cells, and recruited immune populations. We further examine the major experimental systems used to study regeneration, from classic <i>in vivo</i> hepatectomy models to emerging human-relevant platforms, including organoids, liver-on-a-chip systems, extracellular matrix scaffolds, precision-cut liver slices, and <i>ex vivo</i> perfusion, highlighting both their mechanistic value and translational limitations. We then focus on the growing clinical importance of regeneration in transplantation, where the expanding use of marginal, steatotic, aged, and reduced-size grafts has intensified the need to preserve regenerative competence. In this context, <i>ex vivo</i> machine perfusion offers a uniquely promising platform to study, modulate, and therapeutically prime regenerative pathways before implantation, potentially enabling graft reconditioning strategies that improve outcomes in small-for-size and other high-risk liver grafts.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1841091"},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel preoperative simulation approach for pediatric kidney transplantation to support donor-recipient size matching using dialysis fluid-enhanced CT imaging and 3D printing.","authors":"Julia Bojstedt, Lena Gordon Murkes, Vasileios Tsirkos, Johan Nordström","doi":"10.3389/frtra.2026.1861599","DOIUrl":"10.3389/frtra.2026.1861599","url":null,"abstract":"<p><strong>Background: </strong>Size mismatch between adult donor kidneys and small pediatric recipients remains a significant technical challenge in pediatric kidney transplantation. To address this, we explored a novel preoperative method to evaluate donor-recipient anatomical compatibility.</p><p><strong>Methods: </strong>Three pediatric recipients underwent pre-transplant assessments using segmented CT data from living donors to generate patient-specific 3D-printed kidney models. Digital simulation was performed by virtually positioning the donor kidney within fluid-enhanced recipient CT datasets acquired following intraperitoneal dialysis fluid administration. It was hypothesized that this combined approach would enable objective preoperative assessment of spatial fit and surgical feasibility.</p><p><strong>Results: </strong>The preoperative simulation and modeling approach contributed to successful kidney transplantation in all three children without intraoperative complications attributable to graft placement. Postoperative recovery was uneventful, and graft function remained satisfactory at 6-month follow-up.</p><p><strong>Conclusion: </strong>The integration of 3D-printed donor kidneys with digital simulation based on dialysis fluid-enhanced CT imaging offers a feasible approach for preoperative donor-recipient size matching in small pediatric recipients. This method may enhance surgical planning, allow safer use of living-donor organs in very small children, and reduce time spent on dialysis.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1861599"},"PeriodicalIF":0.0,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer-related mortality among solid organ transplant recipients: systematic review and meta-analysis.","authors":"Charlotte Stephens, Rafeea Shah, Azm Hussain, Joseph Sturman, Yimeng Zhang, Felicity Baldwin, David Winter, Mike Hawkins, Raoul Reulen, Adnan Sharif","doi":"10.3389/frtra.2026.1851859","DOIUrl":"10.3389/frtra.2026.1851859","url":null,"abstract":"<p><strong>Background: </strong>Organ transplantation is associated with an increased risk of cancer-related mortality; however, estimates from international cohorts vary widely. The aim of this systematic review and meta-analysis is to quantify this risk.</p><p><strong>Methods: </strong>We searched MEDLINE and OVID Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for population-based cohort studies reporting cancer-related mortality in adult solid organ transplant recipients up to 2nd October 2024. Meta-analysis was conducted using a restricted maximum likelihood random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Seventeen registry-based studies and multicentre cohort studies met inclusion criteria. The pooled standardised mortality ratio for cancer mortality was 2.21 (95% CI: 1.82-2.68). Meta-regression showed higher mortality after heart [mortality rate ratio (MRR) 2.08, 95% CI: 1.28-3.41] and lung (MRR: 1.83, 95% CI: 1.09-3.06; <i>p</i> = 0.025) transplantation compared with kidney transplantation. Geographic variation was observed, with lower mortality in East Asia.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates that solid organ transplantation is associated with an increased in overall cancer-related mortality compared with the general population, with variation by organ type and cancer site. Prostate cancer showed no excess mortality risk, supporting current guidance against additional screening. In contrast, mortality from non-Hodgkin's lymphoma was increased fivefold, consistent with the established link between immunosuppression and post-transplant lymphoproliferative disease. Notably, geographic variation was observed, with lower mortality in East Asia, likely reflecting differences lifestyle risk factors and health care structures. However significant between study heterogeneity exists, underscoring the need for tailored prevention strategies, rather than relying on aggregated global estimates in this high-risk population.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024617474, identifier CRD42024617474.</p>","PeriodicalId":519976,"journal":{"name":"Frontiers in transplantation","volume":"5 ","pages":"1851859"},"PeriodicalIF":0.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13328252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}