812-P: Safety and Efficacy of Early Initiation of GLP1RA and SGLT2 inhibitors, in Post–Kidney Transplant Patients with Type 2 Diabetes

Introduction: DKD is the most common cause of ESKD. Among kidney transplant recipients (KTRs), 40% have DM. Anti-rejection therapies worsen DM and have increased CV mortality >50%. To date, we do not know what the best early therapy is to treat post-transplant patients with type 2 diabetes (T2D). The use of SGLT2i or GLP1-RA, as early anti-diabetic therapy, could improve glucose, weight, cardiovascular and renal function in these patients.

Methods: Retrospective, observational, single-center study using EMR. Inclusion-criteria included KTR with T2D. After 6 months post-transplant, GLP1RA or combination therapy was initiated. A1c, lipids, eGFR, and weight were taken as major outcomes to determine efficacy. Outcomes were measured before and after 18 months of therapy. SE and SAE were recorded.

Results: Twenty-six patients KTR with T2D; 55±2 years-old, A1c 6.8%+/-0.5; BMI 30.2 +/- 1.4 were included. Five subjects were on SGLT2i+GLP1RA and 21 subjects on GLP1RA. There were no significant differences between groups at baseline. The A1c levels in the combination group decreased (-0.14%±0.4) and the GLP1-group (-0.06%±0.4). LDL (-51mg/dL ± 23 vs +0.2mg/dL±8.3), p=0.009. Triglycerides (-10.8mg/dL±10.8 vs -64.8mg/dL±15.7), p=0.05. eGFR (+1.2mL/min vs +6.3mL/min) p=0.25. Weight (-7.8kg±3 vs -4.6kg±2) p=0.2. No patients discontinued the medication due to side effects.

Conclusion: This single-center retrospective analysis showed that both groups treated with either GLP1RA, or its combination with SGLT2i, are safe and effective after 18 months without significant SE. These novel drugs should be considered as a safe early therapy in KTR patients with T2D. As our numbers are small in this real-world data, further randomized studies are necessary to confirm these findings.