Fishman Claire E, Walshe Ciara, Claridge Tamara, Witek Stephanie, Pandya Krishna, Christie Jason D, Diamond Joshua M, Anderson Michaela R
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pharmacy, Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Transplant Proc. 2025 Mar;57(2):342-347. doi: 10.1016/j.transproceed.2024.11.016. Epub 2024 Dec 7.
Diabetes and obesity increase risk of death after lung transplantation. Optimal treatment of diabetes and obesity may improve post-transplant outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are FDA-approved to treat diabetes and obesity and demonstrate improvement in renal and cardiovascular outcomes in the general population. However, side effects may limit tolerability in lung transplant recipients. We hypothesized that GLP-1RA would be stopped due to side effects in a higher proportion of lung transplant recipients compared to the general population but result in weight loss for those who were able to tolerate them.
We performed a single-center case series of lung transplant recipients initiated on a GLP-1RA post-transplant between April 1, 2005 and December 31, 2023. We assessed side effects and complications during GLP-1RA use. Weight was assessed at time of GLP-1RA initiation and 3-, 6-, and 12-months postinitiation.
Fifty-nine lung transplant recipients initiated a GLP-1RA during the study period with a median (IQR) total time of use of 590 (280-891) days. Thirty-seven percent (22/59) stopped the medication due to side effects, with nausea and vomiting being most common. The median (IQR) percent change in weight at 12-months post-GLP-1RA initiation was -2.5% (-8.7% to 1.5%).
We report the largest study evaluating GLP-1RA use in lung transplant recipients. Discontinuation rates are higher and weight loss is lower than in the general population. However, most lung transplant recipients tolerated long-term use of GLP-1RA. Further work is required to identify which recipients are most likely to benefit and how to optimize tolerability.
糖尿病和肥胖会增加肺移植后死亡风险。对糖尿病和肥胖进行优化治疗可能会改善移植后结局。胰高血糖素样肽-1受体激动剂（GLP-1RA）已获美国食品药品监督管理局（FDA）批准用于治疗糖尿病和肥胖，且在普通人群中可改善肾脏和心血管结局。然而，副作用可能会限制肺移植受者的耐受性。我们推测，与普通人群相比，更高比例的肺移植受者会因副作用而停用GLP-1RA，但对于能够耐受的患者，GLP-1RA会导致体重减轻。
我们开展了一项单中心病例系列研究，纳入2005年4月1日至2023年12月31日期间移植后开始使用GLP-1RA的肺移植受者。我们评估了使用GLP-1RA期间的副作用和并发症。在开始使用GLP-1RA时以及开始使用后3个月、6个月和12个月评估体重。
59例肺移植受者在研究期间开始使用GLP-1RA，中位（四分位间距）总使用时间为590（280 - 891）天。37%（22/59）的患者因副作用停药，最常见的是恶心和呕吐。开始使用GLP-1RA后12个月时体重的中位（四分位间距）变化百分比为-2.5%（-8.7%至1.5%）。
我们报告了评估肺移植受者使用GLP-1RA的最大规模研究。停药率高于普通人群，体重减轻幅度低于普通人群。然而，大多数肺移植受者耐受GLP-1RA的长期使用。需要进一步开展工作，以确定哪些受者最可能获益以及如何优化耐受性。
