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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Transplant. Jun 18, 2026; 16(2): 117357
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.117357
Immunosenescence and cancer predisposition in pediatric transplant recipients: An emerging paradigm
Aya Mohamed Adel Arafat, Soliman M A Soliman, Habiba Elfandy, Moamen O Othman, Walaa Elsayed, Mai M Lotfy, Noura A A Ebrahim
Aya Mohamed Adel Arafat, Department of Clinical and Chemical Pathology, Kasr Al-Aini Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Soliman M A Soliman, Department of Chemistry, Faculty of Science, Cairo University, Cairo 12613, Egypt
Habiba Elfandy, Noura A A Ebrahim, Department of Oncologic Pathology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
Moamen O Othman, Department of Pathology, Kasr Al-Aini Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Walaa Elsayed, Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
Walaa Elsayed, Department of Pediatric Oncology, Children’s Cancer Hospital 57357, Cairo 19057, Egypt
Mai M Lotfy, Department of Cancer Biology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
Co-first authors: Aya Mohamed Adel Arafat and Soliman M A Soliman.
Author contributions: Arafat AMA and Ebrahim NAA contributed to the conception and preparation of this manuscript; Arafat AMA, Soliman SMA, Elfandy H, Othman MO, Elsayed W, Lotfy MM, and Ebrahim NAA were all involved in drafting the manuscript and performing critical revisions; Arafat AMA and Soliman SMA contributed equally as co-first authors; all authors approved the final version to publish.
AI contribution statement: Grammarly and QuillBot were used for language refinement only. The scientific content was authored by the authors and was not AI-generated. Grammarly and QuillBot were used solely for language polishing and writing assistance to improve grammar and expression. They were not used for data analysis or translation. Study design, data interpretation, and all scientific judgments were performed entirely by the authors. No images in the manuscript were generated by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Noura A A Ebrahim, Department of Oncologic Pathology, National Cancer Institute, Cairo University, 1st El Kasr El Aini Street, Cairo 11796, Egypt. npathologist@gmail.com
Received: December 5, 2025
Revised: February 9, 2026
Accepted: April 2, 2026
Published online: June 18, 2026
Processing time: 175 Days and 11.1 Hours
Core Tip

Core Tip: Children who undergo organ transplantation often experience premature aging of the immune system, largely due to factors such as anti-thymocyte globulin exposure, cytomegalovirus reactivation, thymic dysfunction, and long-term immunosuppressive therapy. This accelerated immune decline substantially increases their risk of developing cancer both early and later in life. Adopting a biomarker-driven clinical approach, including senescence-related flow cytometry panels, T cell receptor excision circle/telomere assessments, and epigenetic aging markers, along with tailored immunosuppression strategies, vigilant cytomegalovirus management, and emerging therapies targeting senescent, thymic, or metabolic pathways may help lessen cancer risk and improve long-term patient outcomes.

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