SAT-609 - Safety and efficacy of GLP-1 receptor agonists in kidney transplant recipients with type 2 diabetes: a systematic review

Background: Kidney transplant recipients with type 2 diabetes mellitus (T2DM) face increased metabolic, and kidney risks. Although glucagon-like peptide-1 receptor agonists (GLP-1 RA) are well established in the general diabetic population, evidence in transplant recipients is still limited.

Objective: To evaluate the safety and efficacy of GLP-1 RA in kidney transplant recipients with T2DM.

Methods: A systematic review was conducted in accordance with PRISMA protocol. Databases searched included PubMed, BVS, and Cochrane. Two blinded independent researchers performed the selection. Excluded from this review were pediatric studies, recipients of other organ transplants, and those without any clinical or laboratory outcomes of interest. The ROBINS-I tool was used to assess the risk of bias. The search yielded 171 records, after duplicates removed (n = 52), full-text screening, and application of eligibility criteria, three articles were included.

Results: N = 7,012 kidney transplant recipients were treated with Liraglutide, Dulaglutide, Exenatide, or Semaglutide. Follow-up ranged from 24 months to 3.1 years. Intervention improved metabolic control, including an HbA1c reduction of −0.5 ± 1.3% versus −0.1 ± 0.8% (p = 0.01). Renal outcomes favored the therapy, Major adverse kidney events (MAKE) rates were 12.3% in the GLP-1 RA users versus 20.3% in the non-users, with an aHR of 0.66 (95% CI 0.58–0.75). All-cause mortality rates were 2.6% in the GLP-1 RA users compared with 9.0% in the non-users, with an aHR of 0.39 (95% CI 0.31–0.50). The therapy was generally well tolerated, with gastrointestinal symptoms as the most common side effects, primarily nausea and vomiting with an aHR of 1.21 (95% CI 1.02–1.45), with no increase in severe events such as hypoglycemia or pancreatitis.

Conclusion: Current observational evidence suggests that GLP-1 RA offer metabolic, and renal benefits for kidney transplant recipients with T2DM, with a favorable safety profile. Despite promising results, these agents remain underutilized. Future research studies are needed to confirm these findings, define optimal therapeutic approaches, assess drug-drug interactions and guide clinical practice.

Keywords: Organ Transplantation; Kidney Transplantation; Diabetes Mellitus; Glucagon-Like Peptides; Glucagon-Like Peptide-1 Receptor Agonists; Semaglutide; Liraglutide.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*