Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management

Merzkani, Massini; Bentall, Andrew; Smith, Byron H.; Lopez, Xiomara Benavides; D'Costa, Matthew R; Park, Walter D.; Kremers, Walter K.; Issa, Naim; Rule, Andrew D.; Chakkera, Harini A.; Reddy, Kunam S.; Khamash, Hasan; Wadei, Hani M.; Mai, Martin; Alexander, Mariam P.; Amer, Hatem; Kukla, Aleksandra; Ters, Mireille El; Schinstock, Carrie A.; Gandhi, Manish J.; Heilman, Raymond L.; Stegall, Mark D.

doi:10.1097/txd.0000000000001273

Cited by 14 publications

(17 citation statements)

References 16 publications

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“…Obesity and weight gain have demonstrated a harmful influence on graft survival, diabetes, and the risk of cardiovascular disease 3,9,30,31 . Weight gain is most common the first year after transplant, with a reported average gain of 9.16 ± 6.59 kg 32 .…”

Section: Discussionmentioning

confidence: 99%

“…Obesity and weight gain have demonstrated a harmful influence on graft survival, diabetes, and the risk of cardiovascular disease. 3,9,30,31 Weight gain is most common the first year after transplant, with a reported average gain of 9.16 ± 6.59 kg. 32 Although weight values were only able to be trended for one third of our patients, we did see a modest weight decrease of 1.6 kg [0-2.7] three months post initiation.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes mellitus is the leading cause of end‐stage kidney disease among adults listed for transplant, and up to 20% of kidney transplant recipients develop post‐transplant diabetes mellitus (PTDM) 1,2 . Cardiovascular disease is one of the leading causes of death with graft function in kidney transplant recipients (KTR), highlighting the importance of risk minimization with effective diabetes management 3 . Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) are antihyperglycemic agents that induce glucosuria, with clinical trials describing additional benefits, including improved cardiovascular outcomes, weight loss, and kidney function preservation 4–7 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Cardiovascular disease is one of the leading causes of death with graft function in kidney transplant recipients (KTR), highlighting the importance of risk minimization with effective diabetes management. 3 Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are antihyperglycemic agents that induce glucosuria, with clinical trials describing additional benefits, including improved cardiovascular outcomes, weight loss, and kidney function preservation. [4][5][6][7] These benefits are highlighted by SGLT2i placement in diabetes management treatment guidelines encouraging prescriptions independent of hemoglobin A1c (HbA1C) lowering effects in patients with diabetes and chronic kidney disease, heart failure, established atherosclerotic cardiovascular disease, and those at high risk of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

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Sodium‐glucose cotransporter 2 inhibitors for treatment of diabetes mellitus after kidney transplantation

Lemke

Brokmeier

Leung

et al. 2022

Clinical Transplantation

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Introduction: Diabetes mellitus in kidney transplant recipients is a risk factor for cardiovascular events and premature death. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are increasingly used in nontransplant populations to improve diabetes control and cardiovascular and renal benefits. Limited literature exists regarding the safety and efficacy of these agents in renal transplant recipients. Methods:We retrospectively reviewed all kidney transplant recipients within our health system who were prescribed a SGLT2i after transplantation for diabetes. The safety, tolerability, and effectiveness of SGLT2i were analyzed.Results: Thirty-nine kidney transplant recipients were initiated on SGLT2i therapy, twenty-seven of which remained on therapy for at least 1 year. Ten (25%) patients experienced an adverse event while on a SGLT2i, with urinary tract infections (UTI) being the most common. Seventeen patients (43%) discontinued the SGLT2i at the time of chart review, most commonly due to cost and kidney function decline. The median [IQR] hemoglobin A1c (HbA1c) at SGLT2i initiation of 8.4% [7.8-9.2] decreased to 7.5% [6.8-8.0%] after 3 months and 7.5% [6.5-7.9] after 12 months. No meaningful change in kidney function or tacrolimus exposure was observed. Conclusion:SGLT2i may be a safe and effective treatment for diabetes in kidney transplant recipients. Cost is a barrier to SGLT2i therapy, and UTIs were the most frequently encountered adverse events in this cohort. More studies are needed to understand the safety profile and determine the effect of SGLT2i on diabetes-related comorbidities among kidney transplant recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sodium‐glucose cotransporter 2 inhibitors for treatment of diabetes mellitus after kidney transplantation

Lemke

Brokmeier

Leung

et al. 2022

Clinical Transplantation

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“…This is particularly important as infections and cardiovascular disease, both overrepresented in patients with diabetes, are important causes of graft loss. 19 Providers may be hesitant to recommend bariatric surgery, and patients may be reluctant to proceed due to the perceived high risk of complications. There were no major surgical complications in our cohort, where all, but one patient, had a sleeve gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study

et al. 2022

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Background: Obesity is increasingly common in kidney transplant candidates and may limit access to transplantation. Obesity and diabetes are associated with a high risk for post-transplant complications. The best approach to weight loss to facilitate active transplant listing is unknown, but bariatric surgery is rarely considered due to the patient and physician-related apprehension, among other factors. Methods: We aimed to determine the magnitude of weight loss, listing, and transplant rates in 28 candidates with a mean BMI of 44.4 (±4.6) kg/m2 and diabetes treated conservatively for 1-year post-weight loss consultations (Group 1). Additionally, we evaluated 15 patients (Group 2) who met inclusion criteria but received bariatric intervention within the same time frame. All patients completed a multidisciplinary weight management consultation with at least 1 year of follow-up. Results: In the conservatively managed group (Group 1), the mean weight at the time of initial consultation was 126.5 (±18.5) kg, and BMI was 44.4 (±4.6) kg/m2. At 1-year post weight loss consultation, the mean weight decreased by 4.4 ({plus/minus}8.2) kg to 122.9 (±17) kg, and the mean BMI was 43.0 (±4.8) kg/m2, with a total mean body weight decrease of 3%; p=0.01. Eighteen patients (64.2%) did not progress to become candidates for active listing/transplantation during the follow-up time of 4.0 ({plus/minus}2.9) years, with 15 (53.6%) subsequently developing renal failure/diabetes-related comorbidities prohibitive for transplantation. In contrast, mean total body weight decreased by 19% at 6 months post-bariatric surgery, with a mean BMI of 34.2 ({plus/minus}4) and 32.5 ({plus/minus}3.7) kg/m2 at 6 and 12 months, respectively. Bariatric surgery was strongly associated with subsequent kidney transplantation (HR 8.39; [1.71, 41.19]; p=0.0087). Conclusion: A conservative weight loss approach involving multidisciplinary consultation was ineffective in most kidney transplant candidates with diabetes, suggesting a more proactive approach is needed.

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Exploring the single-cell immune landscape of kidney allograft inflammation using imaging mass cytometry

Alexander,

Zaidi,

Larson

et al. 2024

American Journal of Transplantation

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Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management

Abstract: Supplemental Digital Content is available in the text.

Cited by 14 publications

References 16 publications

Sodium‐glucose cotransporter 2 inhibitors for treatment of diabetes mellitus after kidney transplantation

Sodium‐glucose cotransporter 2 inhibitors for treatment of diabetes mellitus after kidney transplantation

Guiding Kidney Transplantation Candidates for Effective Weight Loss: A Clinical Cohort Study

Exploring the single-cell immune landscape of kidney allograft inflammation using imaging mass cytometry

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