V-110.1: The impact of SGLT2 inhibitors on clinical outcomes in kidney transplant recipients with post-transplant diabetes mellitus.

Purpose: The escalating use of sodium glucose cotransporter 2 inhibitors (SGLT2i) in general populations with renal insufficiency to enhance diabetes control and confer cardiovascular and renal benefits has become prominent. However, limited studies exist on the safety and efficacy of these agents in renal transplant recipients, particularly those with post-transplant diabetes mellitus (PTDM). This study aims to assess the influence of SGLT2i use on clinical outcomes in kidney transplant recipients. Methods: A retrospective review was conducted on recipients who underwent kidney transplantation between 2005 and 2020 at two Korean centers. Recipients with PTDM prescribed SGLT2i were weighted using inverse probability of treatment weighting (IPTW) and matched with those using other medications through IPTW and propensity score matching (PSM). Variables for IPTW included participant age, body weight, hypertension status, the number of diabetes medication pills, transplantation date, and the HbA1c level before initiating the index DM medication. Outcomes of interest encompassed changes in eGFR, incidences of graft failure (GF), biopsy-proven acute rejection (BPAR), and bacterial infections, assessed through time-varying Cox proportional hazards models. Results: Over the study period, a total of 4115 recipients underwent kidney transplantation, with 1165 (28.3%) diagnosed with PTDM during a median follow-up of 84.7 months. After applying IPTW, 99 patients were included in SGLT2i user group and 786 were in SGLT2i non-user group. SGLT2i users experienced significant improvements in eGFR compared to non-users at 3 months (74.8 ± 19.8 vs. 66.0 ± 24.0, p < 0.001), 6 months (75.1 ± 20.4 vs. 67.1 ± 23.3, p = 0.002), 9 months (74.0 ± 18.9 vs. 66.7 ± 23.7, p = 0.002), and 12 months (76.8 ± 20.8 vs. 68.2 ± 24.1, p = 0.005). Similarly, lower rates of GF were noted in SGLT2i users (HR, 0.058; 95% CI, 0.012-0.270; p < 0.001). However, no significant association was found between SGLT2i use and BPAR (HR, 0.592; 95% CI, 0.1625-2.156; p = 0.427) or bacterial infections (HR, 3.379; 95% CI, 0.797-14.32; p = 0.098). Mortality did not occur in the SGLT2i user group and was therefore excluded from the analysis.Conclusions: The use of SGLT2 inhibitors in kidney transplant recipients is associated with significant improvements in eGFR and reduced rates of GF, highlighting their potential renal protective effects. However, caution is warranted regarding the risk of bacterial infections. Further studies are needed to clarify the impact of SGLT2i use on BPAR, infection, or cardiovascular effect in this population.