SGLT2 Inhibitors and GLP-1 Receptor Agonists in Kidney Transplantation: A Systematic Review and Meta-Analysis
Pooling 32 studies in 7,834 kidney transplant recipients, both SGLT2 inhibitors and GLP-1 receptor agonists were linked to lower death rates and better heart and kidney outcomes, with weight and HbA1c reductions and no signal of increased infection or pancreatitis.
Background
Kidney transplant recipients experience high rates of cardiovascular disease, allograft dysfunction and post-transplant diabetes, all of which shorten graft and patient survival. SGLT2 inhibitors and GLP-1 receptor agonists confer cardiorenal benefit outside transplantation, but transplant-specific evidence has been fragmentary.
Study design
MEDLINE, Embase and Cochrane were searched through 27 February 2025. 32 studies were pooled using random-effects models: 21 studies (3,856 patients) on SGLT2 inhibitors and 12 studies (3,978 patients) on GLP-1 receptor agonists.
Key findings
In matched-control studies, use of either agent class was associated with reduced mortality and improved cardiovascular and kidney outcomes. Both promoted weight loss (SGLT2 inhibitors SMD -0.59, 95% CI -1.04 to -0.15; GLP-1 receptor agonists SMD -0.27, 95% CI -0.44 to -0.10) and HbA1c reduction (-0.33%, 95% CI -0.55 to -0.12; and -0.48%, 95% CI -0.82 to -0.13 respectively) while kidney function remained stable. SGLT2 inhibitors raised serum magnesium and lowered uric acid.
Safety
No increased risk of infection was seen with SGLT2 inhibitors and no increased risk of pancreatitis with GLP-1 receptor agonists.
Clinical implications
The synthesis supports considering these agents in transplant recipients with diabetes or obesity, with the authors emphasising that randomised trials are still required to confirm efficacy and safety in this high-risk population.
Category
Transplant
Source
Transplantation
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