Pre-transplant hepatocellular carcinoma is associated with increased risk of post-transplant non-HCC cancer in liver transplant recipients.

BACKGROUND: Post-transplant malignancy (PTM) contributes substantially to late morbidity and mortality after liver transplantation (LT), yet contemporary data on cancer spectra across cirrhosis etiologies remain limited. We assessed PTM prevalence, determinants, and cancer-type distribution by pre-LT etiology in a Canadian cohort to inform risk-adapted surveillance in routine practice. METHODS: We conducted a retrospective cohort study of adults undergoing LT at a tertiary Ontario center (2007-2018) with 60-month follow-up. De novo and recurrent malignancies were ascertained through June 2023 using institutional cancer registries. Time-to-event associations with post-LT cancers were evaluated using Cox proportional hazards models. RESULTS: = 0.003). CONCLUSIONS: PTM was common after LT and overall showed etiology-linked cancer spectra. These findings support universal dermatologic surveillance and intensified, individualized screening for recipients with pre-transplant HCC, incorporating underlying liver disease etiology to optimize early detection and long-term outcomes.