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

Abstract

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.