Efficacy and Safety of SGLT2 Inhibitors in Individuals with Sold Organ Transplantation: A Systematic Review and Meta-analysis

Despite the growing body of evidence supporting the beneficial effects of sodium-glucose transporter 2 (SGLT-2) inhibitors on metabolic, cardiovascular, renal, and mortality outcomes in the wide range of diseases, clinical data in patients with solid organ transplantation (SOT) is limited. A systematic literature search was conducted in PubMed, Scopus, and Web of Science from database inception until April 14, 2025, to evaluate the efficacy and safety of SGLT-2 inhibitors in patients with SOT. Among 25 studies, 18 included kidney transplant recipients. There was considerable heterogeneity between the remaining studies regarding design, setting, and outcomes. The meta-analysis of two interventional studies showed the beneficial effects of SGLT-2 inhibitors on body mass index (BMI) (-2.564, 95% CI: -4.982 to -0.146, I²=0%, P=0.0377), weight (-0.800, 95% CI: -0.878 to -0.722, I²=0%, P<0.0001), and hemoglobin A1c (HbA1c) (-0.447, 95% CI: 0.085 to 0.810, I²=0%, P=0.0155) in the kidney transplant population. The mortality benefits of SGLT-2 inhibitors in the kidney transplant population have been shown in observational studies with large sample sizes. Despite the benefits of SGLT-2 inhibitors on metabolic outcomes and their satisfactory safety profiles represented in most eligible studies, these medications should be used with caution in patients with SOT, particularly in high-risk patients. Additional well-designed studies are needed to reveal the efficacy and safety of SGLT-2 inhibitors in patients with SOT.