{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T05:37:01Z","timestamp":1740116221132,"version":"3.37.3"},"reference-count":45,"publisher":"Baishideng Publishing Group Inc.","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Transplant"],"abstract":"BACKGROUND<\/jats:p>\n Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection. However, the risk of malignancy associated with prolonged immunosuppression remains a concern, as it can adversely affect recipients\u2019 quality of life and survival. While the link between immunosuppression and increased cancer risk is well-documented, the specific interactions between graft rejection and post-transplant malignancy (PTM) remain poorly understood. Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.<\/jats:p>\n AIM<\/jats:p>\n To investigate whether immunosuppression in PTM reduces rejection risk, while immune activation during rejection protects against malignancy.<\/jats:p>\n METHODS<\/jats:p>\n We analyzed data from the United Network for Organ Sharing\u2019s Organ Procurement and Transplantation Network database (1987\u20132023) on adult, first-time, single-organ transplant recipients with no prior history of malignancy (in donors or recipients). Landmark analyses at 1, 2, 3, 5, 10, 15, and 20 years post-transplant, Kaplan\u2013Meier analyses, and time-dependent Cox proportional hazards regression models, each incorporating the temporal dimension of outcomes, assessed the association between rejection-induced graft failure (RGF) and PTM. Multivariate models were adjusted for clinical and immunological factors, including immunosuppression regimens.<\/jats:p>\n RESULTS<\/jats:p>\n The cohort included 579905 recipients (kidney: 386878; liver: 108390; heart: 45046; lung: 37643; pancreas: 1948) with a mean follow-up of 7.3 years and a median age of 50.6 \u00b1 13.2 years. RGF was associated with a reduction in PTM risk across all time points [hazard ratio (HR) = 0.07-0.20, P < 0.001], even after excluding mortality cases. Kidney transplant recipients exhibited the most pronounced reduction (HR = 0.22, P < 0.001). Conversely, among recipients with PTM, RGF risk decreased across all time points up to 15 years after excluding mortality cases (HR = 0.49\u20130.80, P < 0.001). This risk reduction was observed in kidney, liver, heart, and lung transplants (HRs = 0.90, 0.21, 0.21, and 0.18, respectively; P < 0.001) but not in pancreas transplants.<\/jats:p>\n CONCLUSION<\/jats:p>\n RGF reduces PTM risk, particularly in kidney transplants, while PTM decreases RGF risk in kidney, liver, heart, and lung transplants.<\/jats:p>","DOI":"10.5500\/wjt.v15.i2.102384","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:40:41Z","timestamp":1740098441000},"source":"Crossref","is-referenced-by-count":0,"title":["Novel association between graft rejection and post-transplant malignancy in solid organ transplantation"],"prefix":"10.5500","volume":"15","author":[{"given":"Hye Sung","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wongi","family":"Woo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Geun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankit","family":"Bharat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Kwang","family":"Chae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2060","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/AS9.0000000000000383"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.10.018"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2018111101"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0247449"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241210301"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1592"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.30531"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002378"},{"key":"B9","unstructured":"Nation Cancer Institute. 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