Impact of Glucagon-like Peptide-1 Receptor Agonists on Metabolic Health in Liver Transplant Recipients.

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), initially approved for the management of diabetes, have demonstrated a wide range of metabolic benefits. However, their benefit and safety profile in liver transplant (LT) recipients remain poorly defined.

Methods: This study retrospectively analyzed adults who had undergone LT and had concomitant type 2 diabetes mellitus. Thirty-eight post-LT recipients treated with GLP-1RA for type 2 diabetes mellitus were matched with patients treated with insulin therapy 1:1 using propensity scoring for age, sex, ethnicity, cause of cirrhosis, and immunosuppression. This matching aimed to assess the metabolic effects and safety profile of GLP-1RA after LT.

Results: The 2 groups were similar at baseline with regard to clinical characteristics, except that time from LT was greater in patients who were on GLP-1RA. Semaglutide was the most commonly used GLP-1RA. LT recipients who received GLP-1RA lost approximately 8% of body weight during 12 mo, whereas patients on insulin therapy gained approximately 10% of body weight during the same period. Patients on GLP-1RA were less likely to have hepatic steatosis compared with patients on insulin therapy post-LT. Both GLP-1 and insulin were well tolerated, with no significant impact on renal function, immunosuppression, or rejection. GLP-1RA was stopped in only 1 patient due to persistent nausea.

Conclusions: GLP-1RA therapy is safe after LT and is well tolerated. Aside from glycemic control, metabolic benefits of GLP-1RA included weight loss and lower prevalence of steatosis in LT recipients. The study findings provide much-needed safety data for GLP-1RA in LT patients and foundational data to design prospective trials to evaluate metabolic benefits of GLP-1RA.