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Objective This systematic review describes the efficacy, safety, and drug interactions of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose transport protein 2 (SGLT2) inhibitors in kidney transplant recipients (KTRs). Data Sources Articles were identified by English-language MEDLINE search, published prior to May 2020, using the terms kidney transplant, OR PTDM, OR NODAT, AND metformin, OR DPP4, OR GLP1, OR SGLT2. Study Selection and Data Extraction All selected studies were included if the study population was composed of adult KTRs who were diagnosed with either impaired glucose tolerance, diabetes mellitus (DM), new-onset diabetes after transplant (NODAT), or posttransplantation diabetes mellitus (PTDM). Data Synthesis In KTRs, there is evidence for safety with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors. However, urinary tract infections and a slight initial decrease in renal function may limit use of SGLT2 inhibitors. As compared with the nontransplant type 2 DM population, SGLT2 inhibitors are not as efficacious in KTRs. Relevance to Patient Care and Clinical Practice This review provides an overview of the current literature on newer antidiabetic agents, addressing efficacy, safety, and drug interactions to help guide clinical decision-making for their use in KTRs. Conclusion Newer antidiabetic agents have been recommended by the American Diabetes Association for potential cardiovascular, renal, and hypoglycemic benefits. Particular agents, such as DPP-4 inhibitors and GLP-1 RAs may play a role in correcting PTDM-related defects. Clinicians need to take into account both patient-specific and drug-specific characteristics when initiating these agents in KTRs.

Pre-existing opioid use is common in kidney transplant patients with a significant amount continuing to use opioids post-transplant. 1 For kidney transplant patients, pre-transplant opioid use is more likely due to multiple sources of acute and chronic pain related to endstage renal disease (ESRD). 1 Pain in this population is typically managed with both non-opioid and opioid analgesics. 2 Surgical patients with pre-operative opioid use have a higher rate of post-operative opioid use when compared to opioid-naïve patients, which places kidney transplant recipients in a vulnerable position. 3,4 Although overall incidence remains low, use of opioids after kidney transplant has been associated with twofold increased risk of death and 68% increased risk of all-cause graft failure during the one year posttransplant period when high level opioid users were compared to patients with no opioid use. 1

Oropharyngeal candidiasis, or OC, is a fungal infection associated with immunosuppression among solid organ transplant recipients. [1][2][3][4][5][6] OC presents as soft yellowish-white plaques or diffuse erythematous patches on the oral mucosa, which can cause patients to experience a cottony feeling in the mouth, altered taste and sense of smell, odynophagia, and dysphagia. 4 OC development can predispose patients to more severe manifestations such as esophageal candidiasis and disseminated Candida infections. 7

Patient: Female, 57-year-old Final Diagnosis: Chronic obstructive pulmonary disease (COPD) Symptoms: Dyspnea • hypoxia Medication: — Clinical Procedure: Transplantation Specialty: Surgery • Transplantology Objective: Unusual setting of medical care Background: Heparin-induced thrombocytopenia (HIT) is an immunological response to heparin exposure that predisposes patients to hypercoagulable reactions with subsequent heparin administration. Traditionally, heparin is the standard anticoagulant used during organ procurement to prevent clot formation in grafts. This creates a problem in donors or recipients that develop HIT as they are at risk of developing life-threatening coagulopathy. This raises the question of how to use alternative anticoagulation therapies, such as argatroban, that provide rapid-onset prophylaxis by reversibly inhibiting thrombin. Additionally, there are few studies that have assessed how recipients of multiorgan donors treated with argatroban do post-operatively. Case Report: In this report, we discuss the procurement protocol and hospital course of a lung transplant recipient who received a graft treated with argatroban due to a HIT-positive liver recipient. The post-operative course for our patient was uneventful, with improved lung function and no complications attributable to argatroban use. Further, none of the 4 other recipients who received organs from the same donor experienced graft dysfunctions secondary to coagulopathy, including the HIT-positive liver recipient. Conclusions: The ultimate success of grafts without thromboembolic complications suggests the use of argatroban in multi-organ procurement in the setting of a HIT-positive recipient is safe and effective. This case report highlights an alternative to the traditional process of organ procurement with heparin, in which patients at risk of coagulopathies secondary to HIT are able to receive organs when traditional protocols would otherwise be prohibitive.