Purpose: Sodium-glucose cotransporter 2 (SGLT2) inhibition has been shown to reduce cardiovascular mortality and preserve kidney function in patients with type 2 diabetes. Kidney transplant recipients with diabetes demonstrate increased risk and accelerated progression of micro- and macrovascular complications. However, potential concerns of SGLT2 inhibition include volume depletion and acute kidney injury as well as urinary tract infections. Here we report safe application of SGLT2 inhibitors in an ongoing case series of patients after kidney transplantation.

Methods: Kidney transplant recipients started on empagliflozin for better glucose control were included in the analysis. Patients with a stable allograft function (eGFR ≥ 45 ml/min/1.73m[sup2]) were eligible for SGLT2 inhibition. Empagliflozin was given as add-on to preexisting antidiabetic treatment with dose reduction of the latter. Patients were asked to ensure adequate hydration and urogenital hygiene.

Results: To date, 7 patients have entered the analysis. Median eGFR at baseline was 61 ml/min/1.73m[sup2] with a median time since transplantation of 6.9 yrs. Median HbA1c prior to treatment was 7.6%, median fasting plasma glucose 168 mg/dl. During follow-up, kidney allograft function remained stable in all patients. No side effects were reported. Required insulin doses decreased by 46 % and HbA1c could be markedly improved. Updated results from the ongoing analysis will be presented.

Conclusions: SGLT2 inhibition is safe and efficient in selected kidney transplant recipients with diabetes. Glucose control can be improved despite reduction in concomitant antidiabetic treatment. Whether SGLT2 inhibition is able to reduce cardiovascular mortality and improve allograft survival in these patients has to be addressed in further studies.

CITATION INFORMATION: Guthoff M., Mahling M., Nadalin S., Heyne N. SGLT2 Inhibition in Kidney Transplant Recipients with Diabetes Am J Transplant. 2017;17 (suppl 3).

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