Are There Any Renoprotective Effects of SGLT2 Inhibitors in Heart Transplant Recipients with Diabetes?

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown renoprotective effects in diabetic patients, however their impact on heart transplant recipients remains controversial due to limited data.

Methods: This retrospective cohort study included heart transplant recipients with diabetes from January 2016 to December 2023. The patients were divided into a treatment group who used SGLT2 inhibitors for at least 1 year, and a control group who had never used SGLT2 inhibitors. We used propensity score matching to balance baseline characteristics between the two groups. The primary outcome was a renal-specific composite, including a sustained decline of ≥ 50% in estimated glomerular filtration rate (eGFR), end-stage kidney disease, or death from renal causes.

Results: After 15-18 months, the SGLT2 inhibitor group showed significant improvements in eGFR compared to the control group. The renal-specific composite outcome occurred less frequently in the SGLT2 inhibitor group compared with the control group (log-rank test, p = 0.0064). The SGLT2 inhibitor group had a lower risk of the renal-specific composite outcome compared to the control group, and this finding was consistent across the study cohort [adjusted hazard ratio (aHR): 0.30; p = 0.0270] and propensity-matched cohort (aHR: 0.26; p = 0.0341).

Conclusions: The long-term use of SGLT2 inhibitors in heart transplant recipients with diabetes mellitus was associated with significant renal function preservation and reduced risk of adverse renal outcomes. These findings support the renoprotective potential of SGLT2 inhibitors in this population, warranting further prospective studies.