The Efficacy and Safety of SGLT2 Inhibitor in Diabetic Kidney Transplant Recipients

Lee

et al. 2022

Sci Rep

Self Cite

Posttransplantation diabetes mellitus (PTDM) is an important metabolic complication after KT that causes graft failure and cardiovascular complications in kidney transplantation (KT) recipients. Using the national claim data of South Korea, 7612 KT recipients between 2009 and 2017 were analyzed. PTDM was defined as a consecutive 30-day prescription history of antidiabetic medication after KT. Among these patients, 24.7% were diagnosed with PTDM, and 51.9% were diagnosed within 6 months after KT. Compared to patients without PTDM, those with PTDM were older, more likely to be men, more likely to be diagnosed with hypertension and cardio-cerebrovascular disease, and experienced more rejection episodes requiring high-dose steroid treatment after KT. During the follow-up, 607 DCGFs, 230 DWGFs, 244 MACEs, and 260 all-cause mortality events occurred. Patients with PTDM showed a higher risk of DCGF (adjusted hazard ratio [aHR] 1.49; 95% confidence interval [CI] 1.22–1.82; P < 0.001) and MACEs (aHR 1.76; 95% CI 1.33–2.31; P < 0.001) than patients without PTDM. The risks for all clinical outcomes were higher in the insulin group than in the non-use insulin group. PTDM in KT recipients resulted in both worse allograft and patient outcomes represented by DCGF and MACE, especially in patients needing insulin treatment.

Section: Discussionmentioning

confidence: 98%

Clinical outcomes of posttransplantation diabetes mellitus in kidney transplantation recipients: a nationwide population-based cohort study in Korea

Lee

et al. 2022

Sci Rep

Self Cite

“…PMID: 32241009 (reference 28). (12,19,(25)(26)(27)(28)(29). The routine recommendation for SGLT2i use in diabetic and nondiabetic kidney transplant recipients for their potential cardioand reno-protective effects awaits further studies.…”

Section: General Comments About Sglt2imentioning

confidence: 99%

Optimal use of SGLT2 inhibitors in diabetic kidney transplant recipients

Pham

Pham²

2022

Front. Nephrol.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i), a glucosuric agent initially approved for use as an antidiabetic agent, was unexpectedly found to confer cardio-and reno-protective effects in individuals with or without type 2 diabetes mellitus. Despite mounting evidence suggesting that SGLT2i provides cardio- and reno-protective benefits in both diabetic and non-diabetic and in chronic kidney disease (CKD) patients in the general population, reservations for its use in the transplant setting persist due to concerns for increased risk of genital mycotic and urinary tract infections. A comprehensive review of the literature on the efficacy and safety of SGLT2i use in diabetic kidney transplant recipients is herein presented followed by authors’ opinion on its optimal use in this patient population.

Current Opinion in Organ Transplantation

“…In transplant patients, the data are limited to one RCT, small case series (Table 2), [69–76 ▪▪ ] and a larger retrospective cohort study [77 ▪▪ ]. The prospective, double-blind RCT compared empagliflozin to placebo in 44 recipients at least 1-year posttransplant, demonstrating improved glycaemic control and weight loss with empagliflozin [70].…”

Section: Strategies To Slow Progression Of Kidney Diseasementioning

confidence: 99%

How to maximize graft survival

Lim

Bloom²

2022

Purpose of review Kidney transplant failure results in significant patient morbidity and mortality, increased financial burden and exacerbates the organ shortage faced by kidney transplant candidates. The different strategies to maximize graft survival in kidney transplant recipients is presented in this review. Recent findings Maximizing kidney graft survival requires optimizing immunosuppression, preventing and managing recurrent disease and using general chronic kidney disease strategies to slow allograft injury. Herein, we review: 1) strategies to tailor immunosuppression to the individual patient to avoid over and underimmunosuppression, and avoid immunosuppression-related drug toxicities, 2) latest findings in the following recurrent diseases: focal segmental glomerulosclerosis, membranous nephropathy, complement-mediated kidney disease and monoclonal gammopathy of renal significance, and, 3) approaches to slow allograft injury including BP control, and the use of antiproteinuric agents and SGLT-2 inhibitors. Summary The last two decades has seen significant improvement in allograft outcomes resulting from advances in immunosuppression. With the federal government's renewed focus on kidney disease and transplantation, and recent advances in biomarkers, genetic testing, big data analytics and machine learning, we hope to see further outcome improvements in the next decade.