*Purpose: GLP-1 receptor agonists have been shown to improve glucose control and diabetes-related comorbidities, including obesity, cardiovascular disease and chronic kidney disease, in non-transplant patients. Although GLP-1 receptor agonists represent a promising therapeutic approach to diabetes after solid-organ transplant, the safety and efficacy of these drugs in transplant recipients have not been adequately studied. In particular, there are concerns regarding gastrointestinal (GI) side effects and absorption of the transplant medications in patients taking GLP-1 receptor agonists.

*Methods: Retrospective analysis was performed on 17 transplant recipients who were started on GLP-1 receptor agonists: 14 received kidney transplant alone, 2 combined heart-kidney transplant and one combined liver- kidney transplant. Mean time post transplant was 161.5 months +/- 140. The most common reason to start the medication was to promote the weight loss and to improve blood glucose control. 14 recipients received Liraglutide, 1 Exenatide and 2 Dulaglutide.

*Results: Among the cohort, 64% were male with a median age of 51.7 years [40-62] and BMI of 35.8 ±4.6 kg/m². Mean eGFR was 50 ± 13.2 ml/min/1.73 m2 at the time of initiation of GLP-1 receptor agonists. Patients were on the following immunosuppressive regimen: 13 patients: Tacrolimus, CellCept and prednisone, 1 patient: Tacrolimus only, 2 patients: Tacrolimus and CellCept. Three patients (17%) discontinued GLP-1 receptor agonist within a month of the initiation; 2 of them due to GI side effects and 1 required conversion to insulin. Of the remaining patients, majority were able to tolerate GLP-1 receptor agonists without any significant problems and were taking the following doses by the end of the observation: Liraglutide 1.8 mg daily (7 patients), 1.2 mg daily (5 patients), 0.6 mg daily (1 patient), Exenatide 2 mg weekly (1 patient) Dulaglutide 1.5 mg (1 patient) and 0.5 mg (1 patient) weekly. Weight loss and decreased insulin requirements were noted by the end of follow up, while kidney function remained stable (Table). None of the patients experienced acute rejection during the follow up period. No change was noted in Tacrolimus dosing.

*Conclusions: GLP-1 receptor agonists may be a safe and effective treatment for solid-organ transplant recipients with type 2 diabetes. Discontinuation rate due to the side effects was low and similar to the non-transplant population. More studies are needed to evaluate cardiovascular and renal benefits of GLP-1 receptor agonists in this population.

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