{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:06:53Z","timestamp":1792804013381,"version":"4.5.0"},"reference-count":73,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania","id":[{"id":"https:\/\/ror.org\/03a64bh57","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Kidney transplant recipients (KTRs) experience improved survival and quality of life compared to dialysis treatment, but chronic immunosuppression may increase the risk of de novo post-transplant cancer. Colorectal cancer (CRC) is increasingly recognized in this population. This systematic review aims to synthetize contemporary evidence on CRC epidemiology, outcomes, and risk determinants among KTRs. Methods: A comprehensive search for observational and registry-based studies reporting CRC in adult KTRs was conducted on PubMed, Scopus, Web of Science, and ProQuest. The studies found were subsequently subjected to screening, data extraction, and the risk-of-bias appraisal process. Due to heterogeneity, findings were synthesized narratively. Results: Twenty-six studies encompassing 863,005 KTRs met inclusion criteria: 22 retrospective cohorts, 1 prospective cohort, 2 cross-sectional, and 1 case-control. Absolute CRC occurrence varies by geography, population, and follow-up. Reported risks ranged from no excess to modestly elevated standardized incidence ratios (SIRs): ~0.76\u20133.60 overall, with a right-sided colon predominance. Overall, higher mortality and worse prognosis were reported in kidney transplant recipients with colorectal cancer compared to the general population, as a result of later-stage diagnosis and more aggressive histologies. Consistent risk factors included older age, time since transplantation, diabetes and metabolic comorbidities, prior dialysis duration\/graft failure, and smoking; the female sex showed higher relative CRC risk in some cohorts. The remarkable role of immunosuppression profiles was consistently highlighted: cyclosporine\u2014azathioprine maintenance and alemtuzumab induction were associated with higher CRC risk in large registries, whereas tacrolimus\u2014mycophenolate regimens showed lower risk signals and mTOR inhibitors suggested possible protective effects. Conclusions: Contemporary evidence suggests a modest, heterogenous increase in CRC risk among KTRs, a proximal (right-sided) predominance, and a tendency toward advanced-stage presentation with reduced survival. These findings justify the need to consider risk-tailored, lifelong surveillance strategies anchored in a full colonoscopy, with earlier initiation in younger or otherwise high-risk recipients, alongside careful optimization and periodic re-evaluation of immunosuppression. Prospective multicenter studies and cost-effectiveness analyses should refine screening thresholds and therapeutic strategies. PROSPERO ID: CRD420251071658.<\/jats:p>","DOI":"10.3390\/cancers17203352","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T10:28:36Z","timestamp":1760696916000},"page":"3352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Epidemiological Overview of Colorectal Cancer in Kidney Transplant Recipients: A Systematic Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2031-0449","authenticated-orcid":false,"given":"Francesco","family":"Leonforte","sequence":"first","affiliation":[{"name":"Department of Integrated Hygiene, Organizational, and Service Activities (Structural Department), Health Management, University Hospital Polyclinic \u201cG. Rodolico\u2013San Marco\u201d, 95130 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5294-7173","authenticated-orcid":false,"given":"Antonio","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG. F. Ingrassia\u201d, University of Catania, 95131 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1348-6438","authenticated-orcid":false,"given":"Vito","family":"Nicosia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG. F. Ingrassia\u201d, University of Catania, 95131 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Micalizzi","sequence":"additional","affiliation":[{"name":"Helios Klinikum M\u00fcnchen West, 81242 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Londrigo","sequence":"additional","affiliation":[{"name":"Department of Integrated Hygiene, Organizational, and Service Activities (Structural Department), Health Management, University Hospital Polyclinic \u201cG. Rodolico\u2013San Marco\u201d, 95130 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9911-5227","authenticated-orcid":false,"given":"Martina Maria","family":"Giambra","sequence":"additional","affiliation":[{"name":"Organ Transplant Unit, University Hospital of Catania, 95130 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Roscitano","sequence":"additional","affiliation":[{"name":"Organ Transplant Unit, University Hospital of Catania, 95130 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierfrancesco","family":"Veroux","sequence":"additional","affiliation":[{"name":"Organ Transplant Unit, University Hospital of Catania, 95130 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2780-6421","authenticated-orcid":false,"given":"Massimiliano","family":"Veroux","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies \u201cG. 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