Prevention of cardiac allograft vasculopathy – A new possible indication for SGLT-2 inhibitors?

Rotkvić, Petra Grubić; Berković, Maja Cigrovski; Rotkvić, Luka; Bulj, Nikola

doi:10.1016/j.mehy.2020.109594

Cited by 8 publications

(3 citation statements)

References 39 publications

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“…Individuals with PTDM after kidney and other solid organ transplantation, and even more so those with type 2 diabetes who have a known pretransplant history of hyperglycemia, are particularly affected by CKD and ASCVD. In consequence, it is sensible to implement recommendations for novel antidiabetics in the solid organ post‐transplant setting, as has already been proposed for liver [145] and heart transplant patients [146]. To date, there are, however, no studies showing that treatment of PTDM actually positively modifies outcomes, other than glycemia.…”

Section: Management Of Ptdm: Novel Antidiabeticsmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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Summary Post‐transplant diabetes mellitus (PTDM) shows a relationship with risk factors including obesity and tacrolimus‐based immunosuppression, which decreases pancreatic insulin secretion. Several of the sodium–glucose‐linked transporter 2 inhibitors (SGLT2is) and glucagon‐like peptide 1 receptor agonists (GLP1‐RAs) dramatically improve outcomes of individuals with type 2 diabetes with and without chronic kidney disease, which is, as heart failure and atherosclerotic cardiovascular disease, differentially affected by both drug classes (presumably). Here, we discuss SGLT2is and GLP1‐RAs in context with other PTDM management strategies, including modification of immunosuppression, active lifestyle intervention, and early postoperative insulin administration. We also review recent studies with SGLT2is in PTDM, reporting their safety and antihyperglycemic efficacy, which is moderate to low, depending on kidney function. Finally, we reference retrospective case reports with GLP1‐RAs that have not brought forth major concerns, likely indicating that GLP1‐RAs are ideal for PTDM patients suffering from obesity. Although our article encompasses PTDM after solid organ transplantation in general, data from kidney transplant recipients constitute the largest proportion. The PTDM research community still requires data that treating and preventing PTDM will improve clinical conditions beyond hyperglycemia. We therefore suggest that it is time to collaborate, in testing novel antidiabetics among patients of all transplant disciplines.

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Section: Management Of Ptdm: Novel Antidiabeticsmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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“…On top of health lifestyle measures that include PA, oral hypoglycaemic medications alone or in combination with insulin therapy are warranted. The new oral antidiabetics such as sodium—glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) seem to be safe according to the first studies and are promising, especially in the setting of transplant vasculopa-thy (GLP1-RA) or renal failure (SGLT2 inhibitors) after HTx [ 101 , 102 ]. However, after HTx there are no indications to continue SGLT2 inhibitor therapy if it was prescribed prior to surgery.…”

Section: Prevention After Heart Transplantationmentioning

confidence: 99%

Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT

Simonenko,

Hansen,

Niebauer

et al. 2024

Transpl Int

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Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients’ physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.

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“…SGLT-2 inhibitors have also been shown to improve cardiovascular outcomes in the general nontransplant population, even in nondiabetic patients. Furthermore, they exhibit anti-inflammatory and antifibrotic effects that may prove beneficial in the prevention of CAV [61]. However, there have not yet been any studies assessing their impact on CAV development or cardiovascular mortality in the OHT population.…”

Section: Anti-hyperglycemic Therapymentioning

confidence: 99%

Noninvasive methods to reduce cardiac complications postheart transplant

Zhou

Wolfson

Vaidya

2021

Current Opinion in Organ Transplantation

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Purpose of reviewLong-term success of heart transplantation is limited by allograft rejection and cardiac allograft vasculopathy (CAV). Classic management has relied on frequent invasive testing to screen for early features of rejection and CAV to allow for early treatment. In this review, we discuss new developments in the screening and prevention of allograft rejection and CAV. Recent findingsNewer noninvasive screening techniques show excellent sensitivity and specificity for the detection of clinically significant rejection. New biomarkers and treatment targets continue to be identified and await further studies regarding their utility in preventing allograft vasculopathy. SummaryNoninvasive imaging and biomarker testing continue to show promise as alternatives to invasive testing for allograft rejection. Continued validation of their effectiveness may lead to new surveillance protocols with reduced frequency of invasive testing. Furthermore, these noninvasive methods will allow for more personalized strategies to reduce the complications of long-term immunosuppression whereas continuing the decline in the overall rate of allograft rejection.

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Prevention of cardiac allograft vasculopathy – A new possible indication for SGLT-2 inhibitors?

Cited by 8 publications

References 39 publications

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT

Noninvasive methods to reduce cardiac complications postheart transplant

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