胰高血糖素样肽 1 受体激动剂 (GLP1-RA) 在糖尿病肾移植受者中的疗效、耐受性和安全性

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-15 DOI:10.1111/ctr.70144

Henry Zelada, Mario Campana, Kosuke Kawai, David Redden, Gaurav Agarwal, Orlando M. Gutierrez, Vineeta Kumar

{"title":"胰高血糖素样肽 1 受体激动剂 (GLP1-RA) 在糖尿病肾移植受者中的疗效、耐受性和安全性","authors":"Henry Zelada, Mario Campana, Kosuke Kawai, David Redden, Gaurav Agarwal, Orlando M. Gutierrez, Vineeta Kumar","doi":"10.1111/ctr.70144","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Uncontrolled diabetes after solid-organ transplantation has been associated with weight gain, high cardiovascular mortality, and transplant rejection. The current standard of care for uncontrolled diabetes after KT is insulin. Recently GLP1-RA have been proposed as an adjuvant medication for those with obesity, but there are concerns for side effects and safety.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Adults (<i>n</i> = 50) with diabetes who underwent KT from at a single academic medical center were included. This is a retrospective study of 25 recipients on insulin ± oral antidiabetic medications who initiated GLP1-RA, and 25 recipients on insulin ± oral agents. Metabolic issues and safety were evaluated before starting GLP1RA, and 6 and 12 months after. The linear mixed effects model was used to evaluate the mean difference in the change in the outcome between the two groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>KT participants were on average 56 years of age, 64% male, with T2D. The primary outcome of change in weight 12 months after initiation of GLP1-RA on an average was −10.1 pounds in the GLP1-RA group, compared to +6.0 pounds in the non-GLP1-RA group (<i>p</i> < 0.01), the change in BMI 12 months after initiation of GLP1-RA on an average was −1.7 kg/m<sup>2</sup> in the GLP1-RA group compared to +1.1 kg/m<sup>2</sup> in the non-GLP1-RA group (<i>p</i> < 0.01), and the change in creatinine 12 months after starting GLP1-RA was on average −0.2 mg/dL in the GLP1-RA group and on average +0.3 mg/dL in the non-GLP1-RA group (<i>p</i> < 0.01). The change in proteinuria 12 months after starting GLP1-RA was on average −128.4 in the GLP1-RA and on average +15.4 mg/dL in the controls (<i>p</i> < 0.01). The rate of GLP1-RA discontinuation was 0%.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Well-selected post-kidney transplant participants demonstrated good tolerance for GLP-1RA. Participants who took GLP1-RA had better glycemic control, more weight loss, a decrease in daily insulin requirements, better preservation of kidney function, and reduced proteinuria 7 12 months after initiation of GLP1-RA compared to those who did not. GLP1-RA did not alter tacrolimus levels or doses.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 4","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy, Tolerability, and Safety of Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) in Kidney Transplant Recipients With Diabetes\",\"authors\":\"Henry Zelada, Mario Campana, Kosuke Kawai, David Redden, Gaurav Agarwal, Orlando M. Gutierrez, Vineeta Kumar\",\"doi\":\"10.1111/ctr.70144\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Uncontrolled diabetes after solid-organ transplantation has been associated with weight gain, high cardiovascular mortality, and transplant rejection. The current standard of care for uncontrolled diabetes after KT is insulin. Recently GLP1-RA have been proposed as an adjuvant medication for those with obesity, but there are concerns for side effects and safety.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Adults (<i>n</i> = 50) with diabetes who underwent KT from at a single academic medical center were included. This is a retrospective study of 25 recipients on insulin ± oral antidiabetic medications who initiated GLP1-RA, and 25 recipients on insulin ± oral agents. Metabolic issues and safety were evaluated before starting GLP1RA, and 6 and 12 months after. The linear mixed effects model was used to evaluate the mean difference in the change in the outcome between the two groups.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>KT participants were on average 56 years of age, 64% male, with T2D. The primary outcome of change in weight 12 months after initiation of GLP1-RA on an average was −10.1 pounds in the GLP1-RA group, compared to +6.0 pounds in the non-GLP1-RA group (<i>p</i> < 0.01), the change in BMI 12 months after initiation of GLP1-RA on an average was −1.7 kg/m<sup>2</sup> in the GLP1-RA group compared to +1.1 kg/m<sup>2</sup> in the non-GLP1-RA group (<i>p</i> < 0.01), and the change in creatinine 12 months after starting GLP1-RA was on average −0.2 mg/dL in the GLP1-RA group and on average +0.3 mg/dL in the non-GLP1-RA group (<i>p</i> < 0.01). The change in proteinuria 12 months after starting GLP1-RA was on average −128.4 in the GLP1-RA and on average +15.4 mg/dL in the controls (<i>p</i> < 0.01). The rate of GLP1-RA discontinuation was 0%.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Well-selected post-kidney transplant participants demonstrated good tolerance for GLP-1RA. Participants who took GLP1-RA had better glycemic control, more weight loss, a decrease in daily insulin requirements, better preservation of kidney function, and reduced proteinuria 7 12 months after initiation of GLP1-RA compared to those who did not. GLP1-RA did not alter tacrolimus levels or doses.</p>\\n </section>\\n </div>\",\"PeriodicalId\":10467,\"journal\":{\"name\":\"Clinical Transplantation\",\"volume\":\"39 4\",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70144\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70144","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

摘要

导言：实体器官移植后未得到控制的糖尿病与体重增加、高心血管死亡率和移植排斥反应有关。目前，治疗 KT 术后未控制糖尿病的标准药物是胰岛素。最近，GLP1-RA 被提议作为肥胖症患者的辅助药物，但其副作用和安全性令人担忧。方法纳入在一家学术医疗中心接受 KT 的成人糖尿病患者（n = 50）。这是一项回顾性研究，研究对象包括 25 名使用胰岛素和口服抗糖尿病药物并开始使用 GLP1-RA 的受试者，以及 25 名使用胰岛素和口服药物的受试者。在开始使用 GLP1-RA 之前以及之后的 6 个月和 12 个月，对代谢问题和安全性进行了评估。采用线性混合效应模型评估两组结果变化的平均差异。结果 KT参与者平均年龄56岁，64%为男性，患有T2D。开始服用 GLP1-RA 12 个月后，GLP1-RA 组的体重变化平均为 -10.1磅，而非 GLP1-RA 组为 +6.0磅（p <0.01）；开始服用 GLP1-RA 12 个月后，GLP1-RA 组的体重指数变化平均为 -1.7kg/m2，而非 GLP1-RA 组为 +1.0kg/m2（p <0.01）。开始服用 GLP1-RA 12 个月后，GLP1-RA 组的血肌酐变化平均为 -0.2毫克/分升，而非 GLP1-RA 组的血肌酐变化平均为 +0.3毫克/分升（p <0.01）。开始服用 GLP1-RA 12 个月后，GLP1-RA 组的蛋白尿变化平均为 -128.4 mg/dL，对照组的蛋白尿变化平均为 +15.4 mg/dL（p <；0.01）。GLP1-RA的停药率为0%。结论经过精心挑选的肾移植术后患者对 GLP-1RA 有良好的耐受性。与未服用 GLP1-RA 的患者相比，服用 GLP1-RA 的患者血糖控制更好，体重减轻更多，每日胰岛素需求量减少，肾功能保存更好，开始服用 GLP1-RA 7 12 个月后蛋白尿减少。GLP1-RA 不会改变他克莫司的水平或剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Efficacy, Tolerability, and Safety of Glucagon-Like Peptide 1 Receptor Agonists (GLP1-RA) in Kidney Transplant Recipients With Diabetes

Introduction

Uncontrolled diabetes after solid-organ transplantation has been associated with weight gain, high cardiovascular mortality, and transplant rejection. The current standard of care for uncontrolled diabetes after KT is insulin. Recently GLP1-RA have been proposed as an adjuvant medication for those with obesity, but there are concerns for side effects and safety.

Methods

Adults (n = 50) with diabetes who underwent KT from at a single academic medical center were included. This is a retrospective study of 25 recipients on insulin ± oral antidiabetic medications who initiated GLP1-RA, and 25 recipients on insulin ± oral agents. Metabolic issues and safety were evaluated before starting GLP1RA, and 6 and 12 months after. The linear mixed effects model was used to evaluate the mean difference in the change in the outcome between the two groups.

Results

KT participants were on average 56 years of age, 64% male, with T2D. The primary outcome of change in weight 12 months after initiation of GLP1-RA on an average was −10.1 pounds in the GLP1-RA group, compared to +6.0 pounds in the non-GLP1-RA group (p < 0.01), the change in BMI 12 months after initiation of GLP1-RA on an average was −1.7 kg/m² in the GLP1-RA group compared to +1.1 kg/m² in the non-GLP1-RA group (p < 0.01), and the change in creatinine 12 months after starting GLP1-RA was on average −0.2 mg/dL in the GLP1-RA group and on average +0.3 mg/dL in the non-GLP1-RA group (p < 0.01). The change in proteinuria 12 months after starting GLP1-RA was on average −128.4 in the GLP1-RA and on average +15.4 mg/dL in the controls (p < 0.01). The rate of GLP1-RA discontinuation was 0%.

Conclusions

Well-selected post-kidney transplant participants demonstrated good tolerance for GLP-1RA. Participants who took GLP1-RA had better glycemic control, more weight loss, a decrease in daily insulin requirements, better preservation of kidney function, and reduced proteinuria 7 12 months after initiation of GLP1-RA compared to those who did not. GLP1-RA did not alter tacrolimus levels or doses.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.