The incidence of cancer in transplant recipients is indisputably higher than that of the age-matched general population, and the increased cancer development in transplant recipients who require immunosuppression to avoid graft rejection is well recognized. This Review discusses the advances with mTOR inhibitors that interfere with tumour development via immune and non-immune mechanisms, and the current and future perspectives on how best to normalize the unacceptably high rates of post-transplantation malignancies are highlighted.