Demir Mehmet Emin, Helvacı Özant, Yıldırım Tolga, Merhametsiz Özgür, Sezer Siren
Department of Nephrology, Atılım University Faculty of Medicine, Ankara, Turkey.
Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
Clin Transplant. 2025 Sep;39(9):e70233. doi: 10.1111/ctr.70233.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated renoprotective and cardioprotective benefits beyond their antiglycemic effects. Their potential utility in kidney transplant recipients (KTRs) for preserving graft function and reducing rejection risk is currently under active investigation. Preliminary studies indicate that SGLT-2i therapy stabilizes estimated glomerular filtration rate (eGFR), decreases glomerular hyperfiltration, and improves metabolic outcomes in KTRs. Emerging clinical evidence also suggests that SGLT-2i may be associated with reduced rates of acute rejection, although direct immunosuppressive actions remain unclear. Experimental findings further suggest that SGLT-2i modulates gene regulation pathways involved in inflammation, oxidative stress, and fibrosis, contributing to improved allograft outcomes. Current safety data in KTRs are reassuring, without significant increases in urinary tract infections or adverse graft events. Nevertheless, long-term prospective studies specific to transplant populations are lacking. This review summarizes available evidence regarding the mechanisms of action, clinical efficacy, and safety profile of SGLT-2i in kidney transplantation, emphasizing their metabolic, hemodynamic, inflammatory, and immunomodulatory effects.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）已显示出除降糖作用之外的肾脏保护和心脏保护益处。目前正在积极研究其在肾移植受者（KTR）中对于维持移植肾功能和降低排斥风险的潜在效用。初步研究表明，SGLT-2i治疗可稳定估算肾小球滤过率（eGFR），降低肾小球高滤过，并改善KTR的代谢结局。新出现的临床证据还表明，SGLT-2i可能与急性排斥发生率降低有关，尽管其直接免疫抑制作用尚不清楚。实验结果进一步表明，SGLT-2i可调节参与炎症、氧化应激和纤维化的基因调控途径，有助于改善移植肾结局。目前KTR的安全性数据令人放心，尿路感染或移植相关不良事件并未显著增加。然而，缺乏针对移植人群的长期前瞻性研究。本综述总结了关于SGLT-2i在肾移植中的作用机制、临床疗效和安全性的现有证据，重点强调了其代谢、血流动力学、炎症和免疫调节作用。
