Should We Screen Sooner? Elevated CRC Incidence in Solid Organ Transplant Recipients in the United States Before and After the COVID-19 Pandemic.

Background: Solid organ transplant (SOT) recipients have an elevated malignancy risk due to long-term immunosuppression; however, the risk of colorectal cancer (CRC) is not well characterized, and current screening guidelines are not tailored to this population. Methods: We used the TriNetX U.S. Collaborative Network to identify adults with SOT (kidney, liver, heart, or lung transplantation) between 2005 and 2025. SOT patients were propensity-score matched 1:1 to non-transplant controls, and CRC incidence at the 10-year and 20-year follow-up was compared. Sensitivity analyses evaluated CRC incidence before (2015-2019) and after (2020-2024) the COVID-19 pandemic onset. Results: We identified 90 510 SOT recipients (matched to 90 510 controls from 9.8 million general patients). After matching, the baseline characteristics were balanced. SOT recipients had a higher cumulative incidence of CRC than controls at both 10 years (0.17% of kidney transplant patients vs. 0.02% of controls; Conclusion: SOT recipients in the United States exhibit a significantly higher long-term CRC risk, a disparity that appears to have widened after the pandemic. These findings underscore the need to revisit CRC screening strategies in SOT recipients, particularly older and long-term transplant survivors.