Published In
Turkish Journal of Gastroenterology
Volume 37 · Issue 4
Pages: 510-523
History
Published Online: February 20, 2026
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright © 2026 Nilay Danış, Hüseyin Döngelli, Tarkan Ünek, Aylin Bacakoğlu, İlker Turan, Abdullah Zeki Karasu, Fulya Günşar, Elvan Işık, Muhsin Murat Harputluoglu, Kutay Sağlam, Sezai Yılmaz, Bilger Çavuş, Sabahattin Kaymakoglu, Haydar Adanır, Dinç Dinçer, Derya Arı, Meral Akdogan Kayhan, Dilara Turan Gokce, Gökhan Kabacam, Sedat Karademir, Murat Kıyıcı, Selcan Cesur, Hale Gokcan, Zeynep Melekoglu Ellik, Ramazan İdilman, Murat Dayangaç, Yasemin Balaban, Ahmet Bülent Doğrul, Hilmi Anıl Dinçer, Gupse Adalı, Feyza Dilber, Murat Taner Gulsen, Orhan Sezgin, Zekiye Nur Harput, Murat Akyıldız, Kenan Moral, Tufan Egeli, Cihan Ağalar, Mücahit Özbilgin, Mesut Akarsu
Nilay Danış
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Hüseyin Döngelli
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Tarkan Ünek
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Aylin Bacakoğlu
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
İlker Turan
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Abdullah Zeki Karasu
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Fulya Günşar
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Elvan Işık
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Muhsin Murat Harputluoglu
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Kutay Sağlam
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Sezai Yılmaz
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Bilger Çavuş
Liver Transplantation Center, İstanbul University Hospital, İstanbul, Türkiye
Sabahattin Kaymakoglu
Liver Transplantation Center, İstanbul University Hospital, İstanbul, Türkiye
Haydar Adanır
Liver Transplantation Center, Akdeniz University Hospital, Antalya, Türkiye
Dinç Dinçer
Liver Transplantation Center, Akdeniz University Hospital, Antalya, Türkiye
Derya Arı
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Meral Akdogan Kayhan
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Dilara Turan Gokce
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Gökhan Kabacam
Liver Transplantation Center, Güven Hospital, Ankara, Türkiye
Sedat Karademir
Liver Transplantation Center, Güven Hospital, Ankara, Türkiye
Murat Kıyıcı
Liver Transplantation Center, Bursa Uludağ University Hospital, Bursa, Türkiye
Selcan Cesur
Liver Transplantation Center, Bursa Uludağ University Hospital, Bursa, Türkiye
Hale Gokcan
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Zeynep Melekoglu Ellik
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Ramazan İdilman
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Murat Dayangaç
Liver Transplantation Center, İstanbul Medipol University Hospital, İstanbul, Türkiye
Yasemin Balaban
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Ahmet Bulent Dogrul
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Hilmi Anıl Dinçer
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Gupse Adalı
Liver Transplantation Center, Ümraniye Training and Research Hospital, İstanbul, Türkiye
Feyza Dilber
Liver Transplantation Center, Marmara University Hospital, İstanbul, Türkiye
Murat Taner Gulsen
Liver Transplantation Center, Gaziantep University Hospital, Gaziantep, Türkiye
Orhan Sezgin
Liver Transplantation Center, Mersin University Hospital, Mersin, Türkiye
Zekiye Nur Harput
Liver Transplantation Center, Mersin University Hospital, Mersin, Türkiye
Murat Akyıldız
Liver Transplantation Center, Koç University Hospital, İstanbul, Türkiye
Kenan Moral
Liver Transplantation Center, Ankara Gazi University Hospital, Ankara, Türkiye
Tufan Egeli
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Cihan Ağalar
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Mücahit Özbilgin
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Mesut Akarsu
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Danış, N., Döngelli, H., Ünek, T., Bacakoğlu, A., Turan, İlker, Karasu, A. Z., … Akarsu, M. (2026). De Novo Malignancies after Liver Transplantation: A Multicenter Cohort Study of Incidence, Timing, and Outcomes. Turkish Journal of Gastroenterology, 37(4), 510–523. https://doi.org/10.5152/tjg.2026.25748
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Abstract
Background/Aims: De novo malignancies are an important long-term complication following liver transplantation (LT), driven by chronic immunosuppression and extended post-transplant survival. Understanding patterns by tumor type, timing, and patient characteristics is essential for optimized surveillance. This study aimed to evaluate the clinical characteristics and temporal trends of de novo neoplasms in LT recipients.
Materials and Methods: A total of 6943 adult LT recipients from 16 Turkish centers were evaluated between 1999 and 2023). Two hundred eight patients with 220 histologically confirmed de novo malignancies (excluding hepatocellular carcinoma) were included. Patients who died within 30 days or developed cancer within 90 days post-LT were excluded. Incidence and mortality rates were assessed across post-transplant intervals.
Results: Non-skin solid (53.2%), dermatologic (28.6%), and hematologic (18.2%) cancers were predominant. Most malignancies (76.8%) occurred within 10 years post-LT. Early-onset (<10 years) malignancies were more common in living donor recipients (62.7%, P = .001) and associated with higher mortality (39.6% vs. 11.8%, P < .001). Recipients ≤60 years exhibited a higher incidence of hematologic cancers (23.9% vs. 12.6%, P = .03) and increased mortality (39.4% vs. 27.0%, P = .05). In subgroup analysis, tacrolimus use was strongly associated with cutaneous squamous cell carcinoma (P = .004). Peak incidence occurred 2-10 years post-LT (≈13-14 per 1000 recipients), with non-skin solid tumors being the most frequent.
Conclusion: De novo malignancies remain a significant long-term risk after LT, with outcomes influenced by tumor type, age, immunosuppression, and timing of onset. Risk-adapted surveillance and tailored oncologic management, particularly dermatologic screening in tacrolimus-treated patients and enhanced surveillance during the 2-10 year post-transplant period are recommended to improve long-term survival.
Cite this article as: Danış N, Döngelli H, Ünek T, et al. De novo malignancies after liver transplantation: A multicenter cohort study of incidence, timing, and outcomes. Turk J Gastroenterol. 2026;37(4):510-523.
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Article Info
Published In
Journal
Turkish Journal of Gastroenterology
Volume / Issue
Volume 37 · Issue 4
Pages
510-523
History
Published Online
February 20, 2026
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
Copyright (c) 2026 Nilay Danış, Hüseyin Döngelli, Tarkan Ünek, Aylin Bacakoğlu, İlker Turan, Abdullah Zeki Karasu, Fulya Günşar, Elvan Işık, Muhsin Murat Harputluoglu, Kutay Sağlam, Sezai Yılmaz, Bilger Çavuş, Sabahattin Kaymakoglu, Haydar Adanır, Dinç Dinçer, Derya Arı, Meral Akdogan Kayhan, Dilara Turan Gokce, Gökhan Kabacam, Sedat Karademir, Murat Kıyıcı, Selcan Cesur, Hale Gokcan, Zeynep Melekoglu Ellik, Ramazan İdilman, Murat Dayangaç, Yasemin Balaban, Ahmet Bülent Doğrul, Hilmi Anıl Dinçer, Gupse Adalı, Feyza Dilber, Murat Taner Gulsen, Orhan Sezgin, Zekiye Nur Harput, Murat Akyıldız, Kenan Moral, Tufan Egeli, Cihan Ağalar, Mücahit Özbilgin, Mesut Akarsu
Affiliations
Nilay Danış
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Hüseyin Döngelli
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Tarkan Ünek
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Aylin Bacakoğlu
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
İlker Turan
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Abdullah Zeki Karasu
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Fulya Günşar
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Elvan Işık
Liver Transplantation Center, Ege University Hospital, İzmir, Türkiye
Muhsin Murat Harputluoglu
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Kutay Sağlam
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Sezai Yılmaz
Liver Transplantation Center, İnonu University Hospital, Malatya, Türkiye
Bilger Çavuş
Liver Transplantation Center, İstanbul University Hospital, İstanbul, Türkiye
Sabahattin Kaymakoglu
Liver Transplantation Center, İstanbul University Hospital, İstanbul, Türkiye
Haydar Adanır
Liver Transplantation Center, Akdeniz University Hospital, Antalya, Türkiye
Dinç Dinçer
Liver Transplantation Center, Akdeniz University Hospital, Antalya, Türkiye
Derya Arı
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Meral Akdogan Kayhan
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Dilara Turan Gokce
Liver Transplantation Center, Ankara Bilkent City Hospital, Ankara, Türkiye
Gökhan Kabacam
Liver Transplantation Center, Güven Hospital, Ankara, Türkiye
Sedat Karademir
Liver Transplantation Center, Güven Hospital, Ankara, Türkiye
Murat Kıyıcı
Liver Transplantation Center, Bursa Uludağ University Hospital, Bursa, Türkiye
Selcan Cesur
Liver Transplantation Center, Bursa Uludağ University Hospital, Bursa, Türkiye
Hale Gokcan
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Zeynep Melekoglu Ellik
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Ramazan İdilman
Liver Transplantation Center, Ankara University Hospital, Ankara, Türkiye
Murat Dayangaç
Liver Transplantation Center, İstanbul Medipol University Hospital, İstanbul, Türkiye
Yasemin Balaban
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Ahmet Bulent Dogrul
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Hilmi Anıl Dinçer
Liver Transplantation Center, Hacettepe University Hospital, Ankara, Türkiye
Gupse Adalı
Liver Transplantation Center, Ümraniye Training and Research Hospital, İstanbul, Türkiye
Feyza Dilber
Liver Transplantation Center, Marmara University Hospital, İstanbul, Türkiye
Murat Taner Gulsen
Liver Transplantation Center, Gaziantep University Hospital, Gaziantep, Türkiye
Orhan Sezgin
Liver Transplantation Center, Mersin University Hospital, Mersin, Türkiye
Zekiye Nur Harput
Liver Transplantation Center, Mersin University Hospital, Mersin, Türkiye
Murat Akyıldız
Liver Transplantation Center, Koç University Hospital, İstanbul, Türkiye
Kenan Moral
Liver Transplantation Center, Ankara Gazi University Hospital, Ankara, Türkiye
Tufan Egeli
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Cihan Ağalar
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Mücahit Özbilgin
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Mesut Akarsu
Liver Transplantation Center, Dokuz Eylül University Hospital, İzmir, Türkiye
Cite this Article
Danış, N., Döngelli, H., Ünek, T., Bacakoğlu, A., Turan, İlker, Karasu, A. Z., … Akarsu, M. (2026). De Novo Malignancies after Liver Transplantation: A Multicenter Cohort Study of Incidence, Timing, and Outcomes. Turkish Journal of Gastroenterology, 37(4), 510–523. https://doi.org/10.5152/tjg.2026.25748
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