Medical Approaches to Prevent Immunosuppression-Associated Oncogenesis in Organ Transplant Recipients: A Comprehensive Review

Solid organ transplantation (SOT) is a life-saving intervention for end-stage organ failure, but its long-term success is challenged by the profound consequences of chronic immunosuppression, most notably a significantly elevated risk of de novo malignancy. Solid organ transplant recipients (SOTRs) face a two- to five-fold higher incidence of cancer and a greater than twofold increase in cancer-related mortality compared to the age-matched general population. This comprehensive review synthesizes the current body of evidence on the prevention of immunosuppression-associated oncogenesis in SOTRs. The heightened cancer risk is a multifactorial process driven by three primary mechanisms: the profound impairment of cancer immune surveillance, the reactivation of latent oncogenic viruses such as Epstein-Barr virus (EBV), Human Papillomavirus (HPV), and Human Herpesvirus 8 (HHV-8), and the direct carcinogenic properties of certain immunosuppressive agents. This review details the epidemiology, pathophysiology, and risk factors associated with post-transplant malignancies, provides an in-depth analysis of medical and pharmacological prevention strategies, and outlines essential screening, surveillance, and non-pharmacological preventive measures. Keywords: organ transplantation; immunosuppression; oncogenesis; post-transplant malignancy; mTOR inhibitors; calcineurin inhibitors; cancer prevention; PTLD