Efficacy, Tolerability, and Safety of Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) in Kidney Transplant Recipients With Diabetes.

INTRODUCTION

Uncontrolled diabetes after solid-organ transplantation has been associated with weight gain, high cardiovascular mortality, and transplant rejection. The current standard of care for uncontrolled diabetes after KT is insulin. Recently GLP1-RA have been proposed as an adjuvant medication for those with obesity, but there are concerns for side effects and safety.

METHODS

Adults (n = 50) with diabetes who underwent KT from at a single academic medical center were included. This is a retrospective study of 25 recipients on insulin ± oral antidiabetic medications who initiated GLP1-RA, and 25 recipients on insulin ± oral agents. Metabolic issues and safety were evaluated before starting GLP1RA, and 6 and 12 months after. The linear mixed effects model was used to evaluate the mean difference in the change in the outcome between the two groups.

RESULTS

KT participants were on average 56 years of age, 64% male, with T2D. The primary outcome of change in weight 12 months after initiation of GLP1-RA on an average was -10.1 pounds in the GLP1-RA group, compared to +6.0 pounds in the non-GLP1-RA group (p < 0.01), the change in BMI 12 months after initiation of GLP1-RA on an average was -1.7 kg/m in the GLP1-RA group compared to +1.1 kg/m in the non-GLP1-RA group (p < 0.01), and the change in creatinine 12 months after starting GLP1-RA was on average -0.2 mg/dL in the GLP1-RA group and on average +0.3 mg/dL in the non-GLP1-RA group (p < 0.01). The change in proteinuria 12 months after starting GLP1-RA was on average -128.4 in the GLP1-RA and on average +15.4 mg/dL in the controls (p < 0.01). The rate of GLP1-RA discontinuation was 0%.

CONCLUSIONS

Well-selected post-kidney transplant participants demonstrated good tolerance for GLP-1RA. Participants who took GLP1-RA had better glycemic control, more weight loss, a decrease in daily insulin requirements, better preservation of kidney function, and reduced proteinuria 7 12 months after initiation of GLP1-RA compared to those who did not. GLP1-RA did not alter tacrolimus levels or doses.