Association of glucagon-like peptide-1 receptor agonists with cardiovascular and kidney outcomes in type 2 diabetic kidney transplant recipients
In a large real-world cohort of kidney transplant recipients with type 2 diabetes, those started on a GLP-1 receptor agonist after transplant had substantially lower risks of death, cardiovascular events, and major kidney events than those who were not.
Study design
Using the TriNetX Global Collaborative Network (2006-2023), the authors identified 35,488 adult kidney transplant recipients with type 2 diabetes and applied 1:1 propensity score matching to compare 3,564 who received a GLP-1 receptor agonist within three months post-transplant against 3,564 who did not. The primary outcome was all-cause mortality, with major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE) as secondary outcomes.
Key findings
Over a median 2.5-year follow-up, GLP-1 receptor agonist users had lower risks of mortality (adjusted HR 0.39, 95% CI 0.31-0.50), MACE (aHR 0.66, 95% CI 0.56-0.79), and MAKE (aHR 0.66, 95% CI 0.58-0.75). Only about 9.8% of eligible recipients were using these agents, which the authors flag as a missed opportunity.
Safety
Adverse effects included higher rates of nausea, vomiting, and diarrhea, but no increase in suicide, hypoglycemia, retinopathy, or pancreatitis.
Clinical implications
The results suggest GLP-1 receptor agonists may be underused in diabetic transplant recipients despite a strong association with better survival and cardiorenal outcomes. Because the data are observational, they support but cannot yet prove a benefit, and prospective trials in this population are needed.
Category
Transplant
Source
Cardiovascular Diabetology
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