Recent guidelines support metformin as a therapeutic option in diabetic patients with mild to moderate renal insufficiency. The frequency and outcomes of metformin use in kidney transplant (KTx) recipients are not well described.

We integrated SRTR registry data with diabetes mediation fill records from a large pharmaceutical claims warehouse (2008-2015). Associations (adjusted hazard ratio, 95% _LCLaHR _{95% UCL}) of diabetes regimens (with and without metformin) in the first-year post-transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression including adjustment for recipient, donor and transplant factors, and propensity for metformin use.

Among 14,144 type 2 diabetic KTx recipients in the linked database, 4.7% filled metformin in the first-year post-KTx. Compared to insulin-based regimens (excluding metformin), those who received metformin were more likely to be female (adjusted odds ratio [aOR] 1.27), have discharge estimated glomerular filtration (eGFR) >60 (vs 30-60 ml/min per 1.73m2, aOR 1.35) and be transplanted more recently, and were less likely to have received expanded criteria deceased donor allografts (aOR 0.64). Metformin-based treatment was associated with significantly lower adjusted all-cause (aHR _0.180.41_0.91), malignancy-related (aHR _0.450.45_1.00), and infection-related (aHR _0.120.20_0.85) mortality and a non-significant trend towards lower cardiovascular mortality compared to insulin-based therapies. There was a non-significant trend towards lower risks of graft failure and acute rejection in the metformin group, but no evidence of increased adverse graft or patient outcomes.

Metformin-based diabetes treatment regimens may be safe in carefully selected KTx recipients.

CITATION INFORMATION: Koraishy F., Vest L., Zhang Z., Schnitzler M., Dharnidharka V., Axelrod D., Ouseph R., Naik A., Lam N., Randall H., Alhamad T., Segev D., Brennan D., Kasiske B., Hess G., Lentine K. Metformin Use after Kidney Transplantation: A Safe Option in Carefully Selected Patients Am J Transplant. 2017;17 (suppl 3).

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