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Epidemiology

De novo colorectal cancer after kidney transplantation: a systematic review and meta-analysis

British Journal of Cancer volume 132, pages 1010–1018 (2025)Cite this article

Subjects

Abstract

Background

Kidney transplant (KT) patients have higher risks of developing de novo colorectal cancer (CRC) compared to the general population. However, there is still a knowledge gap in their clinical characteristics, as most single- or multi-center efforts are underpowered and lack generalizability.

Methods

PubMed, Web of Science, Cochrane CENTRAL, and Scopus databases were queried for studies published until July 22nd, 2024. Studies reporting the clinicopathologic characteristics and outcomes of de novo CRC among KT recipients were included.

Results

There were 49 articles included involving 1855 KT patients who developed CRC. The mean time from transplantation to CRC diagnosis was 8·7 years (95%CI 7·2, 10·3 years; I2 = 98·3%). De novo CRC was most commonly located in the ascending colon (43·6%; 95%CI 29·5%, 58·9%; I2 = 55·3%), and 37·1% had advanced CRC at diagnosis (95%CI 22·3%, 54·8%; I2 = 64·1%). Although 68·8% underwent curative intent treatment (95%CI 45·4%, 85·4%; I2 = 65·4%), pooled 5-year survival rate was 31·8% (95%CI 10·5%, 65·1%; I2 = 82·5%).

Conclusions

De novo CRC was diagnosed in under 10 years after KT, and nearly 40% of patients already have advanced stage disease at diagnosis. The pooled rate of 5-year survival was 31.8%. However, there was wide heterogeneity between studies and further research is required. PROSPERO Registration: CRD42023415767.

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Fig. 1: Search results and application of eligibility criteria.
Fig. 2: Forrest plot of mean time from KT to CRC diagnosis in years.
Fig. 3: Pooled overall survival rates and long-term survival of KT patients with de novo CRC.
Fig. 4: Main intracellular pathways within intestinal epithelial cells that may lead to de novo CRC in KT patients.

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Data availability

Data used in the results of this systematic review and meta-analysis, its study protocol, and statistical analysis plan will be made available following publication upon request. Please contact the corresponding author via email with a study proposal (e.g., statistical plan, study protocol) and details regarding how the data will be used.

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Authors and Affiliations

  1. Department of Surgery, University of California, Orange, CA, USA

    Bima J. Hasjim, Arsha Ostowari & Monique Gandawidjaja

  2. Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL, USA

    Mohsen D. Mohammadi

  3. Research Librarian for Health Sciences, University of California, Irvine, CA, USA

    Linda Suk-Ling Murphy

  4. Division of Colon and Rectal Surgery, Department of Surgery, University of California, Orange, CA, USA

    Matthew D. Whealon & Valery Vilchez

  5. Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, USA

    Hirohito Ichii & Robert R. Redfield III

  6. Division of Surgical Oncology, Department of Surgery, University of California, Orange, CA, USA

    Oliver S. Eng

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Contributions

BJH and OSE conceptualized the study. BJH, AO, MG, MM, LSLM, and OSE designed the review and meta-analysis methodology. LSLM conducted the literature search, while BJH, AO, and MG handled the review and data extraction. BJH curated the software and created the visualizations. BJH and MM performed the formal analysis. BJH and OSE drafted the manuscript, with AO, MG, HI, MDW, VV, RRR, OSE, and LSLM reviewing multiple iterations. All authors contributed to interpreting the results, had access to the raw data, and approved the final manuscript. OSE supervised the project.

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Correspondence to Oliver S. Eng.

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Hasjim, B.J., Ostowari, A., Gandawidjaja, M. et al. De novo colorectal cancer after kidney transplantation: a systematic review and meta-analysis. Br J Cancer 132, 1010–1018 (2025). https://doi.org/10.1038/s41416-025-02994-7

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