Key takeaways:

• Patients who receive lung and heart transplants have significantly higher cancer incidence than kidney transplant recipients.
• Bladder, colorectal, genital and lung cancer incidence increases over time.

Cancer incidence after solid organ transplant varies significantly based on transplant and malignancy type.

A study of more than 620,000 patients who received heart, kidney, liver or lung transplant showed that patients who had lung transplants had the greatest incidence rates for solid tumors, nonmelanoma skin cancer and posttransplant lymphoproliferative disorder (PTLD).

Data derived from Andersson C, et al. JAMA Netw Open. 2026;doi:10.1001/jamanetworkopen.2026.31027.

Additionally, bladder, colorectal, genital and lung cancer incidence increased over time, whereas melanoma, thyroid cancer and PTLD rates dropped after high early incidence.

“This is something we should be more observant of, and it should fuel more studies in the field,” Charlotte Andersson, MD, PhD, cardiologist at Heart and Vascular Institute at Mass General Brigham, told Healio.

‘Clinically significant’

The number of solid organ transplants in the U.S. increased more than 50% between 2013 (29,768) and 2024 (46,750), according to the OPTN/SRTR 2024 Annual Data Report.

Five-year OS eclipsed 80% for pancreas (89%), kidney (85.9%), liver (81.8%) and heart (80.6%) transplant recipients. Lung transplant recipients had a 5-year OS of 60%.

“We have become so effective in treating potential rejection that people live longer with their transplanted organs. It’s great,” Andersson said. “However, with that comes other complications. Cancer is one of the things that is a main determinant of how people are doing long-term. It’s something that we encounter frequently in our transplanted patients, unfortunately. I think the lifetime risk of developing cancer is like 20% in all patients with a heart transplant. It’s clinically significant.”

Healio previously reported that individuals who had solid organ transplantation and a history of breast, kidney and lung cancer, as well as other malignancies, had significantly greater risk for developing a second cancer at the same site after transplant.

Andersson and colleagues investigated how transplant type affected overall cancer risk and how risk varied by time since transplant.

Their study included 622,330 individuals (median age, 53 years; interquartile range, 41-61; 62.6% men) who received either kidney (59.8%), liver (23.6%), heart (9.7%) or lung (6.9%) transplant between 2000 and 2023.

Incidence of first-occurring malignancies for each cancer subtype served as the primary endpoint.

‘This is concerning’

Overall, 8% of patients were diagnosed with one cancer and 4,909 developed at least two malignancy types during up to 10 years of follow-up.

Nonmelanoma skin cancers accounted for most of the malignancies (54.9%).

Lung, heart and liver recipients had significantly higher rates of solid organ tumors (lung: incidence rate ratio [IRR] = 2.01; 95% CI, 1.92-2.09; heart: IRR = 1.57; 95% CI, 1.51-1.63; liver: IRR = 1.19; 95% CI, 1.14-1.22) and posttransplant lymphoproliferative disorder (lung: IRR = 2.91; 95% CI, 2.67-3.15; heart: IRR = 1.84; 95% CI, 1.71-1.98; liver: IRR = 1.44; 95% CI, 1.35-1.53) than those who received kidney transplant.

Additionally, nonmelanoma skin cancer occurred significantly more often in patients with lung (IRR = 3.74; 95% CI, 3.62-3.87) and heart (IRR = 2.12; 95% CI, 2.05-2.19) transplants.

With time, the differences in incidence rates increased between lung and heart transplant recipients when compared with kidney transplant patients. Among lung transplant recipients, incidence rate ratios rose substantially from year 1 to years 6-10 for solid tumors (year 1: IRR = 1.21; 95% CI, 1.07-1.37; years 6-10: IRR = 2.72; 95% CI, 2.53-2.91) and nonmelanoma skin cancer (year 1: IRR = 2.01; 95% CI, 1.83-2.21; years 6-10: IRR = 4.46; 95% CI, 4.19-4.75). Heart transplant recipients had increasing incidence rate ratios for solid tumors (year 1: IRR = 0.94; 95% CI, 0.82-1.07; years 6-10: IRR = 1.86; 95% CI, 1.79-1.99), nonmelanoma skin cancer (year 1: IRR = 1.68; 95% CI, 1.52-1.85; years 6-10: IRR = 2.31; 95% CI, 2.17-2.44) and PTLD (year 1: IRR = 1.57; 95% CI, 1.37-1.81; years 6-10: IRR = 2.2; 95% CI, 1.94-2.49).

“This was a bit surprising,” Andersson said. “We don’t know exactly what causes this. It certainly raises the suspicion that it might be the intensity of immunosuppression, which is higher in these organs compared to kidney transplants.”

Melanoma, PTLD and thyroid cancer had high incidence rates in the early posttransplant period, but rates either declined or remained steady afterward.

Researchers observed stable rates for numerous malignancies, including esophageal, kidney, pancreas and stomach cancer, and leukemia.

Bladder, colorectal, genital and lung cancer incidence rates increased throughout 10 years of follow up.

“This is concerning,” Andersson said. “This was distinctly different from the other solid organs, and it also may be related to immunosuppression.

“One hypothesis that I have is that it might be related to viral infections. For instance, genital cancers are often HPV-related, and there are increasing data out there that lung and colon cancers may be related to some viral infections. This hypothesis remains to be tested.”

Researchers acknowledged study limitations, including restricting to first cancers.

“One of the main questions we all have is, how much is immunosuppression doing, and which regimen would be safest to use in terms of the agents we use, but also what is the importance of drug concentrations?” Andersson said. “Some more epidemiological studies in that area would be really helpful. Then, obviously, we also need to figure out who are most at risk clinically.

“We have just started to scratch the surface of a lot of studies that need to come in this area.”

For more information:

Charlotte Andersson, MD, PhD, can be reached at ceandersson@bwh.harvard.edu.