Introduction: Although a slight increase in colorectal cancer (CRC) has been reported post solid organ transplantation when compared to the general population, early and long term outcomes after surgery have not been well investigated. Methods: Solid organ transplant patients with CRC were identified from a prospective CRC and solid organ transplantation database. Early and long term outcomes for such patients undergoing surgery were compared with a control group of patients matched 1:2 for age(+/-5yr), gender, tumor site, year (+/-2yr), ASA score and chemoradiotherapy.Results: 14 solid organ transplantation patients (6 kidney, 5 heart, 1 kidney and pancreas, 1 liver and 1 lung transplantation) developed CRC. Age at diagnosis was 57.1±14.6 yrs. One patient was asymptomatic at diagnosis, although 25% of the patients were under colonoscopic surveillance. Stage at presentation was I or II (n=10), III (one patient) and IV (n=3). Tumor site included right colon (n=6), transverse (n=2), sigmoid (n=3) and rectum and anal canal (n=3). Median time from transplantation to CRC diagnosis was 10 yrs. Cause of death was CRC in 7 out of 11 deceased patients and overall 3 years recurrence rate and disease free survival (DFS) were 35% and 29%, respectively. When compared to the control group, the DFS and overall survival rates were significantly lower in the transplanted patients (29% vs 71%, p=0.02, and 29% vs 75%, p=0.001, respectively). Overall postoperative morbidity rate was slightly increased in post transplant group (21.4% vs 14.3%, p=0.6).Conclusions: Surgery for CRC in post solid organ transplantation patients is safe. CRC occurring in solid organ transplantation patients is associated with worse outcomes when compared to the general population.