Evaluating the use of glucagon-like peptide-1 receptor agonists in a matched cohort of kidney and liver transplant recipients

Abstract

Background

Diabetes mellitus (DM) and obesity are common among solid organ transplant recipients, but are associated with an increased risk of graft failure.

Aim

Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for managing both conditions in the general population, there is limited evidence regarding their use among transplant recipients.

Method

The effect of GLP-1 RAs on post-transplant glucose control (defined as haemoglobin A1c [HbA1c]) among 37 liver and kidney transplant patients was compared to a control cohort. Secondary outcomes included change in total daily insulin requirements and oral DM agents, estimated glomerular filtration rate (eGFR), weight, and body mass index (BMI). Adverse events attributed to GLP-1 RAs, hypoglycaemia, incidence of pancreatitis, biopsy-proven acute rejection, graft loss, and death were assessed. Ethical approval was granted by the Henry Ford Health Institutional Review Board (Reference no: 15959) and the study conforms with the US Federal Policy for the Protection of Human Subjects.

Results

We observed that patients receiving GLP-1 RAs had a median reduction in HbA1c of 0.5% and reduction in insulin and oral anti-DM agents compared to the control group without GLP-1 RAs. There were statistically significant reductions in both weight and BMI in the GLP-1 RA group. Our observed incidence of adverse events was similar to previous literature. Unlike other smaller studies, a decline in eGFR was observed in the GLP-1 RA group. There were no differences in incidence of biopsy-proven acute rejection, graft loss, or death.

Conclusion

When compared to patients without GLP-1 RA therapy, GLP-1 RAs modestly reduced HbA1c and insulin requirements and statistically reduced weight/BMI review at 6 months. GLP-1 RAs, even if initiated early post-transplant, were seemingly safe and effective. Larger, prospective studies are warranted to evaluate the safety and efficacy of GLP-1 RAs in this population.