*Purpose: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been shown to improve glycemic control, blood pressure, cardiovascular mortality, and preserve kidney function 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 increased risks of acute kidney injury and urinary tract infections.

*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 an SGLT2i between January 1, 2015 and December 31, 2020. Efficacy endpoints included change in glycated hemoglobin (HbA1c), blood pressure, kidney function, 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 41 patients (24 kidney, 12 heart, 3 multi-organ, 1 lung, 1 pancreas) received an SGLT2i (20 empagliflozin, 16 dapagliflozin, 3 canagliflozin, and 2 ertugliflozin). Median time from transplant to SGLT2i initiation was 82 [16-104] months. Mean HbA1c at baseline was 7.41%. In the efficacy analysis (table 1), there was a mean decrease in HbA1c of 0.03±1.3% at 3 months (n=12, p=0.93), 0.76±1.9% at 6 months (n=11, p=0.22), and 0.38±1.1% at 12 months (n=9, p=0.33). In the safety analysis, 1 patient developed antibody mediated rejection, 1 acute cellular rejection, 1 graft loss, and 4 patients died. Additionally, 25.6% (n=11) stopped therapy with acute kidney injury being the cause for 2 of these discontinuations. There was a 29.3% (n=12) incidence of urinary tract infection (UTI), but this did not lead to the discontinuation of therapy in any patients.

*Conclusions: SGLT2is 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, SGLT2is can safely be used in diabetic patients post-SOT.

« Back to 2022 American Transplant Congress