Outcomes associated with Sodium-glucose cotransporter-2 inhibitors in kidney transplant recipients: A real-world analysis using a global federated database.

Abstract Rationale & Objective: Several trials have shown the nephroprotective and cardiovascular benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) among patients with native kidney disease. However, little is known about the safety and efficacy of SGLT2i in kidney transplant. The study aimed to investigate the benefits of SGLT2i in kidney transplant recipients. Methods: Retrospective cohort study utilising data from adult kidney transplant recipients (≥ 18 years) was obtained from TriNetX, a global federated health research network. Cohorts were grouped by receipt of SGLT2i and 1:1 propensity-score matched for demographic characteristics, baseline cardiovascular comorbidities, laboratory data and immunosuppression. Cox regression produced hazard ratios with 95% CI for the outcomes. Outcomes: Primary outcome: incident 5-year death-censored graft failure, rejection, major adverse cardiac events and mortality. Secondary outcomes: known complications of SGLT2i. Results: 4,872 patients (mean age 59.2 years SD 12.2; 63% male). Patients in the SGLT2i cohort had statistically significantly reduced death censored graft failure (HR 0.43, 95% CI 0.37-0.51, p <0.0001), rejection (HR 0.44, 95% CI 0.39-0.50, p <0.0001, major adverse cardiovascular events (HR 0.80, 95% CI 0.70, 0.92, p 0.001) and mortality (HR 0.63 95% CI 0.55-0.72, p <0.017). The cohort identified no significant side effects associated with SGLT2i use. Conclusion: Kidney transplant recipients treated with SGLT2i demonstrated a significant reduction in clinically relevant outcomes. The data suggests that they may have a strong beneficial role in the kidney transplant population.