Effects of SGLT2 inhibitors on transplant survival and key clinical outcomes in heart transplant recipients with diabetes

Abstract

Background

Chronic kidney disease and heart allograft vasculopathy are the primary causes of morbidity and mortality after cardiac transplant. This study aimed to evaluate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on transplant survival, cardiovascular events, dialysis, and all-cause mortality in diabetes patients who have undergone heart transplantation.

Methods

In this research, we adopted data from the TriNetX collaborative network to observe outcomes in patients who underwent heart transplants between January 01, 2015 and December 31, 2022. A total of 6494 transplant recipients were identified, from which 1063 matched pairs of SGLT2i users and non-users were selected using propensity score matching. The Kaplan–Meier analysis and Cox proportional hazards models were applied to compare the risks of various outcomes between the study and control groups.

Results

In propensity-matched cohorts, patients using SGLT2i exhibited a lower risk of dialysis [hazard ratio (HR) (95% confidence interval [CI]): 0.566 (0.385–0.833)], graft rejection and failure [0.873 (0.774–0.985)], hospitalizations [0.822 (0.739–0.916)], and all-cause death [0.767 (0.627–0.938)] compared to non-users. Yet, no significant differences were observed between the two groups in the risks of post-transplant infection or sepsis [0.891 (0.739–1.075)], ischemic heart disease (HR: 1.044, 95% CI: 0.939–1.161), and heart failure worsening [0.915 (0.733–1.144)].

Conclusion

This multicenter cohort study demonstrated that cardiac transplant recipients with diabetes who received SGLT2i had a significantly lower risk of dialysis, graft rejection, hospitalization, and all-cause mortality compared to those who did not receive SGLT2i.