This integrative literature review synthesises five strands of recent scholarships on port city regions (PCRs): (1) their multidimensional transitions, (2) skills foresight and future competences, (3) challenges and reforms in vocational education and training (VET) systems, (4) social inclusion and equity in skills development, and (5) innovative VET methodologies in port-adjacent sectors. Drawing on the interdisciplinary academic and policy-oriented literature, this article adopts a qualitative, integrative review approach to examine how the twin green and digital transition is reshaping port city regions and their associated skills ecosystems. The review demonstrates that PCR transitions are not only technical but socio-institutional: while Onshore Power Supplies (OPSs), alternative fuels, and digital platforms are transforming operational landscapes, the success of these innovations depends critically on the adaptive capacity of workers, training systems, and governance arrangements. The article further examines emerging pedagogical approaches in port-adjacent VET, including work-based learning, micro-credentials, and immersive training methods. Taken together, the evidence converges on a central claim: the resilience and sustainability of port city regions depend on integrated skills systems that combine foresight, inclusivity, and pedagogical innovation. Without such systems, decarbonisation and digitalisation risk exacerbating social and spatial inequalities rather than fostering sustainable growth. The article concludes by outlining implications for research, policy, and practice, calling for integrative performance metrics, longitudinal evaluation, and quadruple helix collaboration to support inclusive, competitive, and sustainable port transitions.