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Incidence and long-term risk of de novo malignancies after liver transplantation with implications for prevention and detection
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What this work says
Outgoing claims: the papers this work cites, builds on, or argues with.
inferredcites →https://doi.org/10.1002/lt.20319openalex-snapshot
De Novo Neoplasia After Liver Transplantation: An Analysis of Risk Factors and Influence on Survival
inferredcites →https://doi.org/10.1002/lt.21058openalex-snapshot
De Novo Esophageal Neoplasia After Liver Transplantation
inferredcites →https://doi.org/10.1002/lt.21475openalex-snapshot
Risk of Malignant Neoplasms After Liver Transplantation: A Population-Based Study
inferredcites →https://doi.org/10.1002/lt.21554openalex-snapshot
Liver transplantation and subsequent risk of cancer: Findings from a Canadian cohort study
inferredcites →https://doi.org/10.1002/lt.22064openalex-snapshot
Increased Incidence of Early De Novo Cancer in Liver Graft Recipients Treated with Cyclosporine: An Association with C2 Monitoring and Recipient Age
inferredcites →https://doi.org/10.1002/lt.22247openalex-snapshot
Risk factors of lung, head and neck, esophageal, and kidney and urinary tract carcinomas after liver transplantation
inferredcites →https://doi.org/10.1002/lt.23566openalex-snapshot
Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation
inferredcites →https://doi.org/10.1007/s00117-003-0915-6openalex-snapshot
Stufe-3-Leitlinie - Brustkrebs-Fr�herkennung in Deutschland
inferredcites →https://doi.org/10.1016/0002-9343(84)90861-1openalex-snapshot
Malignancy in primary biliary cirrhosis
inferredcites →https://doi.org/10.1016/j.dld.2009.04.017openalex-snapshot
Comparison of de novo tumours after liver transplantation with incidence rates from Italian cancer registries
inferredcites →https://doi.org/10.1016/j.ejca.2009.12.014openalex-snapshot
Estimates of cancer incidence and mortality in Europe in 2008
inferredcites →https://doi.org/10.1016/j.vaccine.2012.07.055openalex-snapshot
Global Burden of Human Papillomavirus and Related Diseases
inferredcites →https://doi.org/10.1016/s0168-8278(00)00077-5openalex-snapshot
Increased cancer risk after liver transplantation: a population-based study
inferredcites →https://doi.org/10.1016/s0889-8588(05)70473-1openalex-snapshot
TREATMENT OF ORGAN TRANSPLANT–RELATED LYMPHOMA
inferredcites →https://doi.org/10.1016/s1085-5629(96)80019-8openalex-snapshot
Vulvar squamous cell carcinoma
inferredcites →https://doi.org/10.1038/sj.bjc.6601219openalex-snapshot
Cancer risk following organ transplantation: a nationwide cohort study in Sweden
inferredcites →https://doi.org/10.1053/jlts.2001.28645openalex-snapshot
De novo malignancies after liver transplantation: A major cause of late death
inferredcites →https://doi.org/10.1053/jlts.2002.29350openalex-snapshot
De novo tumors after liver transplantation: A single-institution experience
inferredcites →https://doi.org/10.1053/jlts.2002.32977openalex-snapshot
Evidence of differential risk for posttransplantation malignancy based on pretransplantation cause in patients undergoing liver transplantation
inferredcites →https://doi.org/10.1055/s-0030-1253704openalex-snapshot
Die Impfprävention HPV-assoziierter Neoplasien – eine Zusammenfassung der deutschen S3-Leitlinie
inferredcites →https://doi.org/10.1055/s-2006-932556openalex-snapshot
Adjuvante und palliative Chemotherapie des kolorektalen Karzinoms in Deutschland außerhalb kontrollierter Studien
inferredcites →https://doi.org/10.1055/s-2006-933561openalex-snapshot
Primary Sclerosing Cholangitis, Inflammatory Bowel Disease, and Colon Cancer
inferredcites →https://doi.org/10.1093/annonc/mdl498openalex-snapshot
Estimates of the cancer incidence and mortality in Europe in 2006
inferredcites →https://doi.org/10.1093/jnci/89.20.1516openalex-snapshot
Cofactors With Human Papillomavirus in a Population-Based Study of Vulvar Cancer
inferredcites →https://doi.org/10.1097/00007890-200003150-00018openalex-snapshot
LONG-TERM MEDICAL COMPLICATIONS IN PATIENTS SURVIVING ???5 YEARS AFTER LIVER TRANSPLANT
inferredcites →https://doi.org/10.1097/01.tp.0000173775.16579.18openalex-snapshot
Incidence of Cancers Following Orthotopic Liver Transplantation in a Single Center: Comparison with National Cancer Incidence Rates for England and Wales
inferredcites →https://doi.org/10.1097/mot.0b013e3283465715openalex-snapshot
Posttransplant lymphoproliferative disease following liver transplantation
inferredcites →https://doi.org/10.1111/j.1432-2277.2006.00397.xopenalex-snapshot
Incidence and risk factors for the development of lung tumors after liver transplantation
inferredcites →https://doi.org/10.1111/j.1478-3231.2010.02303.xopenalex-snapshot
Risk factors and incidence of de novo malignancy in liver transplant recipients: a systematic review
inferredcites →https://doi.org/10.1111/j.1600-6143.2004.00380.xopenalex-snapshot
De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?
inferredcites →https://doi.org/10.1111/j.1600-6143.2009.02766.xopenalex-snapshot
Extensive Surveillance Promotes Early Diagnosis and Improved Survival of De Novo Malignancies in Liver Transplant Recipients
inferredcites →https://doi.org/10.1111/j.1600-6143.2010.03181.xopenalex-snapshot
Comparison of the Incidence of Malignancy in Recipients of Different Types of Organ: A UK Registry Audit
inferredcites →https://doi.org/10.7326/0003-4819-149-9-200811040-00244openalex-snapshot
Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force
inferredcites →https://doi.org/10.7326/0003-4819-151-10-200911170-00008openalex-snapshot
Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement
inferredcites →https://doi.org/10.7326/m13-2771openalex-snapshot
Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement
What points at this work
Incoming claims: where this work appears in other papers’ reference lists and arguments.
inferred← citeshttps://doi.org/10.1002/9781119251316.ch44openalex-snapshot
Long‐term Management of the Liver Transplant Patient
inferred← citeshttps://doi.org/10.1002/9781119634010.ch55openalex-snapshot
De Novo Malignancies after Liver Transplantation
inferred← citeshttps://doi.org/10.1002/cam4.2995openalex-snapshot
Prostate cancer risk in patients with melanoma: A systematic review and meta‐analysis
inferred← citeshttps://doi.org/10.1002/cam4.6265openalex-snapshot
Lung cancer incidences after liver transplantation: A systematic review and meta‐analysis
inferred← citeshttps://doi.org/10.1002/hed.23943openalex-snapshot
Incidence and long‐term survival of patients with de novo head and neck carcinoma after liver transplantation
inferred← citeshttps://doi.org/10.1002/hep.29636openalex-snapshot
B lymphocytes limit senescence‐driven fibrosis resolution and favor hepatocarcinogenesis in mouse liver injury
inferred← citeshttps://doi.org/10.1002/ijc.31552openalex-snapshot
Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014
inferred← citeshttps://doi.org/10.1002/ijc.31782openalex-snapshot
Survival after the diagnosis of de novo malignancy in liver transplant recipients
inferred← citeshttps://doi.org/10.1002/jhbp.12002openalex-snapshot
Chronological alterations in de novo malignancies after living‐donor liver transplantation: A cohort study of 1781 recipients using annual comparisons of standardized incidence ratios
inferred← citeshttps://doi.org/10.1002/jso.24495openalex-snapshot
De novo thyroid cancer following solid organ transplantation—A 25‐year experience at a high‐volume institution with a review of the literature
inferred← citeshttps://doi.org/10.1002/lt.24795openalex-snapshot
The 28‐year incidence of de novo malignancies after liver transplantation: A single‐center analysis of risk factors and mortality in 1616 patients
inferred← citeshttps://doi.org/10.1002/lt.24869openalex-snapshot
The reality of de novo malignancy: Sadly, not fake news
inferred← citeshttps://doi.org/10.1002/lt.25310openalex-snapshot
Longterm Risk of Solid Organ De Novo Malignancies After Liver Transplantation: A French National Study on 11,226 Patients
inferred← citeshttps://doi.org/10.1002/lt.25336openalex-snapshot
De Novo Malignancies Screening After Liver Transplantation for Alcoholic Liver Disease: A Comparative Opportunistic Study
inferred← citeshttps://doi.org/10.1007/978-1-4939-2947-4_15openalex-snapshot
Recurrent Non-hepatic and De Novo Malignancies After Liver Transplantation
inferred← citeshttps://doi.org/10.1007/978-3-030-82930-8_23openalex-snapshot
De Novo Tumours After Liver Transplantation
inferred← citeshttps://doi.org/10.1007/978-3-319-08084-0_7openalex-snapshot
Cancer Immune Modulation and Immunosuppressive Cells: Current and Future Therapeutic Approaches
inferred← citeshttps://doi.org/10.1007/s00423-014-1214-6openalex-snapshot
Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era
inferred← citeshttps://doi.org/10.1007/s00423-018-1694-xopenalex-snapshot
Renal cell cancer after kidney transplantation
inferred← citeshttps://doi.org/10.1007/s12672-024-01304-6openalex-snapshot
Colorectal cancer in ulcerative colitis after liver transplantation for primary sclerosing cholangitis: a systematic review and pooled analysis of oncological outcomes
inferred← citeshttps://doi.org/10.1016/j.anclin.2017.04.002openalex-snapshot
Infectious Complications and Malignancies Arising After Liver Transplantation
inferred← citeshttps://doi.org/10.1016/j.anl.2017.11.006openalex-snapshot
De novo head and neck cancer arising in solid organ transplantation recipients: The Asan Medical Center experience
inferred← citeshttps://doi.org/10.1016/j.aohep.2022.100683openalex-snapshot
Predictors of solid extra-hepatic non-skin cancer in liver transplant recipients and analysis of survival: A long-term follow-up study
inferred← citeshttps://doi.org/10.1016/j.apnr.2018.11.002openalex-snapshot
Self-management in liver transplantation
inferred← citeshttps://doi.org/10.1016/j.bpg.2020.101680openalex-snapshot
De novo and recurrent malignancy
inferred← citeshttps://doi.org/10.1016/j.ccell.2016.06.009openalex-snapshot
Dual Role of the Adaptive Immune System in Liver Injury and Hepatocellular Carcinoma Development
inferred← citeshttps://doi.org/10.1016/j.cgh.2014.08.018openalex-snapshot
A Greater Proportion of Liver Transplant Candidates Have Colorectal Neoplasia Than in the Healthy Screening Population
inferred← citeshttps://doi.org/10.1016/j.clinre.2020.07.019openalex-snapshot
Risk factors of de novo malignancies after liver transplantation: a French national study on 11004 adult patients
inferred← citeshttps://doi.org/10.1016/j.gastre.2017.10.006openalex-snapshot
Recommendations of everolimus use in liver transplant
inferred← citeshttps://doi.org/10.1016/j.gastrohep.2017.05.008openalex-snapshot
Recomendaciones de uso de everolimus en el trasplante hepático
inferred← citeshttps://doi.org/10.1016/j.gie.2016.12.009openalex-snapshot
Risk of colorectal cancer in chronic liver diseases: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.1016/j.ijsu.2015.11.050openalex-snapshot
Risk of renal cancer in liver transplant recipients: A systematic review and meta-analysis
inferred← citeshttps://doi.org/10.1016/j.jceh.2015.12.002openalex-snapshot
Hepatobiliary Quiz (Answers)—16 (2015)
inferred← citeshttps://doi.org/10.1016/j.jceh.2017.05.209openalex-snapshot
Increased Incidence of Post-transplant Lymphoproliferative Disorder in Autoimmune Liver Disease: An Irish National Experience
inferred← citeshttps://doi.org/10.1016/j.jceh.2020.10.008openalex-snapshot
Extrahepatic Malignancies and Liver Transplantation: Current Status
inferred← citeshttps://doi.org/10.1016/j.jceh.2020.11.003openalex-snapshot
Intrahepatic De Novo Tumors in Liver Recipients are Highly Associated With Recurrent Viral Hepatitis
inferred← citeshttps://doi.org/10.1016/j.jhep.2014.11.023openalex-snapshot
Outcomes in liver transplantation: Does sex matter?
inferred← citeshttps://doi.org/10.1016/j.jhep.2021.02.033openalex-snapshot
A notable proportion of liver transplant candidates with alcohol-related cirrhosis can be delisted because of clinical improvement
inferred← citeshttps://doi.org/10.1016/j.mcna.2016.01.006openalex-snapshot
De Novo Malignancies After Transplantation
inferred← citeshttps://doi.org/10.1016/j.surg.2020.06.044openalex-snapshot
Is thyroid cancer prognosis affected by solid organ transplantation?
inferred← citeshttps://doi.org/10.1016/j.transproceed.2018.06.033openalex-snapshot
De Novo Head and Neck Cancer After Liver Transplant With Antibody-Based Immunosuppression Induction
inferred← citeshttps://doi.org/10.1016/j.transproceed.2021.12.004openalex-snapshot
High Grade Serous Ovarian Carcinoma in a Liver Transplant Recipient Patient: A Case Report and Review of Literature
inferred← citeshttps://doi.org/10.1016/j.transproceed.2024.01.065openalex-snapshot
A Comparative Review of Standardized Incidence Ratios of De Novo Malignancies Post Liver Transplantation in Males Versus Females
inferred← citeshttps://doi.org/10.1016/j.trim.2025.102309openalex-snapshot
High torque Teno virus load is associated with increased all-cause mortality risk in liver transplant recipients: a multicenter cohort study
inferred← citeshttps://doi.org/10.1016/j.trre.2021.100670openalex-snapshot
Review of Standardized Incidence Ratios (SIR) of non-lymphoid de novo malignancies after liver transplantation: Structured analysis of global differences
inferred← citeshttps://doi.org/10.1038/ajg.2017.469openalex-snapshot
ACG Clinical Guideline: Alcoholic Liver Disease
inferred← citeshttps://doi.org/10.1038/nrgastro.2015.172openalex-snapshot
Keys to long-term care of the liver transplant recipient
inferred← citeshttps://doi.org/10.1053/j.gastro.2017.05.045openalex-snapshot
Regulator of Calcineurin 1 Gene Isoform 4, Down-regulated in Hepatocellular Carcinoma, Prevents Proliferation, Migration, and Invasive Activity of Cancer Cells and Metastasis of Orthotopic Tumors by Inhibiting Nuclear Translocation of NFAT1
inferred← citeshttps://doi.org/10.1055/a-1649-8643openalex-snapshot
Der Einsatz der immunonkologischen Therapie beim hepatozellulären Karzinom im Kontext der Lebertransplantation Eine interdisziplinäre Risiko-Nutzen-Abwägung
inferred← citeshttps://doi.org/10.1055/s-0037-1608655openalex-snapshot
Timing, Management, and Outcomes of Liver Transplantation in Primary Sclerosing Cholangitis
inferred← citeshttps://doi.org/10.1080/00365521.2026.2663329openalex-snapshot
Pre-transplant hepatocellular carcinoma is associated with increased risk of post-transplant non-HCC cancer in liver transplant recipients
inferred← citeshttps://doi.org/10.1080/2162402x.2020.1848068openalex-snapshot
Cancer Risks in Solid Organ Transplant Recipients: Results from a Comprehensive Analysis of 72 Cohort Studies
inferred← citeshttps://doi.org/10.1097/mcg.0000000000000886openalex-snapshot
The Care of the Postliver Transplant Patient
inferred← citeshttps://doi.org/10.1097/meg.0000000000001747openalex-snapshot
Incidence of kidney cancer after liver transplantation: a meta-analysis
inferred← citeshttps://doi.org/10.1097/sla.0000000000005831openalex-snapshot
Comprehensive Complication Index to Monitor Morbidity and Mortality After Liver Transplantation in Primary Sclerosing Cholangitis
inferred← citeshttps://doi.org/10.1097/tp.0000000000001725openalex-snapshot
Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis
inferred← citeshttps://doi.org/10.1111/ajt.12555openalex-snapshot
Isolated Peritoneal Donor-Related Plasmacytoma 3 Years After Liver Transplantation: A Case Report
inferred← citeshttps://doi.org/10.1111/ajt.14507openalex-snapshot
Decreasing incidence of cancer after liver transplantation—A Nordic population-based study over 3 decades
inferred← citeshttps://doi.org/10.1111/ans.70133openalex-snapshot
Head and neck cancer after liver transplantation in the north of Spain
inferred← citeshttps://doi.org/10.1111/apm.13296openalex-snapshot
Characteristics of de novo cancer in liver transplant recipients
inferred← citeshttps://doi.org/10.1111/ctr.14714openalex-snapshot
Increasing nonalcoholic steatohepatitis overlap in liver transplant recipients: Additive risk for de novo malignancy
inferred← citeshttps://doi.org/10.1111/hel.12791openalex-snapshot
Preliminary single‐center experience of Helicobacter pylori eradication among the liver transplant recipients
inferred← citeshttps://doi.org/10.1111/liv.12758openalex-snapshot
Incidence of solid organ cancers after liver transplantation: comparison with regional cancer incidence rates and risk factors
inferred← citeshttps://doi.org/10.1111/tid.13513openalex-snapshot
Chronic atrophic gastritis and Helicobacter pylori infection status in liver transplant recipients
inferred← citeshttps://doi.org/10.1136/flgastro-2019-101216openalex-snapshot
Adult liver transplantation: UK clinical guideline - part 2: surgery and post-operation
inferred← citeshttps://doi.org/10.1186/s12894-023-01389-1openalex-snapshot
Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.1186/s40001-015-0117-5openalex-snapshot
Extensive multifocal branch duct IPMN of the pancreas after liver transplantation: is surgery justified?
inferred← citeshttps://doi.org/10.1186/s40779-020-00250-yopenalex-snapshot
Ex vivo limb perfusion for traumatic amputation in military medicine
inferred← citeshttps://doi.org/10.1371/journal.pone.0158732openalex-snapshot
Independent Pre-Transplant Recipient Cancer Risk Factors after Kidney Transplantation and the Utility of G-Chart Analysis for Clinical Process Control
inferred← citeshttps://doi.org/10.15403/jgld.2014.1121.243.gppopenalex-snapshot
The Onset of de novo Hepatocellular Carcinoma after Liver Transplantation can be both of Donor and Recipient origin. A Case Report
inferred← citeshttps://doi.org/10.15825/1995-1191-2026-1-47-63openalex-snapshot
De novo malignancies after liver transplantation: epidemiology, risk factors, and management strategies
inferred← citeshttps://doi.org/10.20517/2394-5079.2020.159openalex-snapshot
Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention
inferred← citeshttps://doi.org/10.20517/mtod.2024.62openalex-snapshot
Post-transplant complications in alcohol- and metabolic-associated steatotic liver disease
inferred← citeshttps://doi.org/10.21037/jgo-24-66openalex-snapshot
Risk of de novo esophageal cancer in liver transplant recipients: systematic review and meta-analysis
inferred← citeshttps://doi.org/10.2174/0126662906402878251122062713openalex-snapshot
The Spectrum of De novo Malignancies After Liver Transplantation: A Review on Current Trends and Surveillance
inferred← citeshttps://doi.org/10.30683/1927-7229.2022.11.04openalex-snapshot
Clinical Features of de Novo Lung Neuroendocrine Tumor after Liver Transplantation for Hepatocellular Carcinoma
inferred← citeshttps://doi.org/10.3389/fonc.2019.00160openalex-snapshot
Dissecting the Multiplicity of Immune Effects of Immunosuppressive Drugs to Better Predict the Risk of de novo Malignancies in Solid Organ Transplant Patients
inferred← citeshttps://doi.org/10.3389/fonc.2021.772348openalex-snapshot
Biological Predictors of De Novo Tumors in Solid Organ Transplanted Patients During Oncological Surveillance: Potential Role of Circulating TERT mRNA
inferred← citeshttps://doi.org/10.3389/fsurg.2022.1068215openalex-snapshot
Successful pancreatoduodenectomy of de novo duodenal malignancy after orthotopic liver transplantation: A case report
inferred← citeshttps://doi.org/10.3390/cancers14020389openalex-snapshot
New Insights into the Epidemiology of Vulvar Cancer: Systematic Literature Review for an Update of Incidence and Risk Factors
inferred← citeshttps://doi.org/10.3390/cancers14092269openalex-snapshot
Upper Gastrointestinal Cancer and Liver Cirrhosis
inferred← citeshttps://doi.org/10.3390/jcm4020260openalex-snapshot
HPV Carcinomas in Immunocompromised Patients
inferred← citeshttps://doi.org/10.3390/jcm9113570openalex-snapshot
Current Challenges in the Post-Transplant Care of Liver Transplant Recipients in Germany
inferred← citeshttps://doi.org/10.3748/wjg.v20.i20.6170openalex-snapshot
Donor transmitted andde novocancer after liver transplantation
inferred← citeshttps://doi.org/10.3748/wjg.v21.i29.8753openalex-snapshot
Neoplastic disease after liver transplantation: Focus onde novoneoplasms
inferred← citeshttps://doi.org/10.3748/wjg.v25.i35.5356openalex-snapshot
De novo malignancies after liver transplantation: The effect of immunosuppressionn-personal data and review of literature
inferred← citeshttps://doi.org/10.3904/kjim.2019.409openalex-snapshot
Alcohol use disorder and liver transplant: new perspectives and critical issues
inferred← citeshttps://doi.org/10.4103/sjmms.sjmms_471_25openalex-snapshot
Incidence of de novo Lymphoproliferative Disorders and Hematological Malignancies in Liver Transplant Recipients: An Updated Meta-Analysis
inferred← citeshttps://doi.org/10.4254/wjh.v7.i7.942openalex-snapshot
Incidence, risk factors and outcome ofde novotumors in liver transplant recipients focusing on alcoholic cirrhosis
inferred← citeshttps://doi.org/10.48350/183556openalex-snapshot
De-novo Upper Gastrointestinal Tract Cancer after Liver Transplantation: A Demographic Report.
inferred← citeshttps://doi.org/10.5500/wjt.v15.i3.101046openalex-snapshot
Incidence, screening, and management of de novo malignancies in liver transplant patients: A review
inferred← citeshttps://doi.org/10.6002/ect.25liver.l49openalex-snapshot
Donor-Transmitted, Donor-Derived, and De Novo Cancer After Liver Transplant
inferred← citeshttps://doi.org/10.6084/m9.figshare.26664340openalex-snapshot
Additional file 1 of Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.6084/m9.figshare.26664343openalex-snapshot
Additional file 2 of Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.6084/m9.figshare.26664349openalex-snapshot
Additional file 3 of Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.6084/m9.figshare.26664352openalex-snapshot
Additional file 4 of Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.6084/m9.figshare.26664355openalex-snapshot
Additional file 5 of Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
inferred← citeshttps://doi.org/10.7150/ijms.66533openalex-snapshot
The Spectrum of Malignant Neoplasms among Liver Transplant Recipients: Sociodemographic Factors, Mortality, and Hospital Burden
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