Glucagon-like Peptide 1 Receptor Agonists and Cardiovascular Outcomes in Solid Organ Transplant Recipients With Diabetes Mellitus

Idit Dotan; Yaron Rudman; Adi Turjeman; Amit Akirov; Tali Steinmetz; Bronya Calvarysky; Talia Diker Cohen

doi:10.1097/TP.0000000000004945

Glucagon-like Peptide 1 Receptor Agonists and Cardiovascular Outcomes in Solid Organ Transplant Recipients With Diabetes Mellitus

Transplantation. 2024 Feb 16. doi: 10.1097/TP.0000000000004945. Online ahead of print.

Authors

Idit Dotan^{1

2}, Yaron Rudman^{1

2}, Adi Turjeman^{2

3}, Amit Akirov^{1

2}, Tali Steinmetz^{2

4}, Bronya Calvarysky^{5

6}, Talia Diker Cohen^{1

2}

Affiliations

¹ Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
⁴ Institute of Nephrology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
⁵ Pharmacy, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
⁶ Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.

PMID: 38361246
DOI: 10.1097/TP.0000000000004945

Abstract

Background: Glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular events and mortality in type 2 diabetes. Limited data are available on diabetes treatment after solid organ transplantation. We aimed to explore the effect of GLP1-RAs on cardiovascular outcomes in transplanted recipients with diabetes.

Methods: We extracted data on adult transplant recipients (kidney, lungs, liver, heart) insured in a large health maintenance organization. Death-censored patients with diabetes treated with GLP1-RAs were matched with nonusers. The primary outcome was a composite of major cardiovascular events (MACEs): a nonfatal cardiac event (myocardial infarction, stable/unstable angina, coronary bypass, and coronary angiography), ischemic stroke and all-cause mortality. Secondary outcomes were MACE or peripheral vascular disease (MACE-PVD), and all-cause mortality. Safety outcomes included biliopancreatic adverse events.

Results: We included 318 patients (69% males, average age 58.3 ± 11.0 y) with a 3.1-y median follow-up. The incidence of MACE was 101 of 1000 patient-years in GLP1-RAs users compared with 134 of 1000 in controls (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.27-0.78). GLP1-RAs similarly reduced the risk of MACE-PVD (HR 0.53; 95% CI, 0.33-0.88) and the risk of all-cause mortality (HR 0.39; 95% CI, 0.18-0.84). Biliopancreatic adverse events occurred less in GLP1-RA users.

Conclusions: Transplant recipients with diabetes who used GLP1-RAs had lower risks for MACE and all-cause mortality. These results may profoundly implicate the daily management of posttransplant recipients with diabetes, a population with a high prevalence of cardiometabolic risk factors and cardiovascular death. Transplant patients are usually excluded from randomized controlled trials and, hence might be undertreated with disease-modifying drugs. Larger prospective studies are needed in this unique population.