*Purpose: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been shown to improve glycemic control, obesity, and cardiovascular disease in the general population. The safety and efficacy of these novel agents have not been adequately studied in transplant recipients. In particular, there are concerns regarding gastrointestinal side effects, which could be exacerbated by mycophenolate use.

*Methods: This retrospective chart review included SOT recipients 18 years of age or older with diabetes either pre- or post-transplant who were treated with a GLP-1 RA between January 1, 2015 and December 31, 2020. Efficacy endpoints included change in glycated hemoglobin (HbA1c), weight, BMI, and insulin use from baseline to 3, 6, and 12 months after initiation using paired t-tests. Safety endpoints included incidence of rejection, graft loss, adverse events, and discontinuation of therapy.

*Results: Total of 90 patients (72 kidney, 17 heart, 3 liver, 2 pancreas, 1 lung) received a GLP-1 RA (39 dulaglutide, 21 liraglutide, 20 semaglutide, 10 exenatide). Median time since transplant was 38 months [19.25-82.75] and 78 (87%) patients were maintained on mycophenolate at time of GLP-1 RA initiation. Mean HbA1c at baseline was 7.85%. In the efficacy analysis (table 1), there was a mean decrease in HbA1c of 0.43±1.6% at 3 months (n=35, p=0.11), 0.52±1.6% at 6 months (n=37, p=0.053), and 0.56±2.1% at 12 months (n=33, p=0.13). Only 33 (37%) patients achieved the labeled maximum dose. In the safety analysis, 5 patients developed antibody mediated rejection, 7 acute cellular rejection, 2 graft loss, and 6 patients died. Additionally, 40 (44.4%) patients discontinued therapy during the study period with 2 (5%) patients citing gastrointestinal adverse effects as the reason for discontinuation.

*Conclusions: GLP-1 RAs were found to be safe and efficacious when used to treat diabetes in a SOT population. Although the primary efficacy endpoint did not reach significance, the study found a low incidence of graft loss and rejection. Additionally, adverse events minimally contributed to the discontinuation of therapy. Despite the lack of definitive efficacy data, GLP1-RAs can safely be used in diabetic patients post-SOT.

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