Key result
GLP-1RAs cut MACE ~45% and reduce all-cause mortality in kidney transplant recipients.
Why the study?
GLP-1 receptor agonists provide cardio-renal benefits in the general population, but evidence in kidney transplant recipients remains limited.
Does GLP-1RA therapy reduce mortality and cardiovascular events in adult kidney transplant recipients?
Does GLP-1RA therapy reduce mortality and cardiovascular events in adult kidney transplant recipients?
GLP-1RA therapy in kidney transplant recipients is associated with significant reductions in mortality and cardiovascular events, alongside improved glycemic control and stable graft function.
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May warrant GLP-1RA in kidney transplant recipients; extends CV benefits to this high-risk immunosuppressed population.
Background Metabolic complications after kidney transplantation (KT) significantly affect graft and patient survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardio-renal benefits in the general population, but evidence in KT recipients remains limited. Methods We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD420251153352). PubMed, Scopus, Web of Science, Ovid MEDLINE, and Cochrane Library were searched to September 2025 for studies evaluating GLP-1RA therapy in adult KT recipients. Random-effects models pooled outcomes for metabolic, renal, cardiovascular, and safety endpoints. Results Seventeen studies (n=54 680 KT recipients) were included. GLP-1RA use significantly reduced all-cause mortality (HR 0.53, 95% CI 0.36–0.79, k=4) and major adverse cardiovascular events (OR 0.55, 95% CI 0.47–0.66; k=3). eGFR remained stable at 3 months, improved at 6 (+1.99 mL/min/1.73 m², 95% CI 0.52 to 3.47, k=5) and 12 months (+2.24 mL/min/1.73 m², 95% CI 0.02 to 4.46, k=6), and was preserved at 24 months. GLP-1RAs lowered HbA1c (MD −0.54%, 95% CI −0.89 to −0.19, k=13) and BMI (SMD −0.32, 95% CI −0.49 to −0.15, k=12) from baseline, with parallel reductions in insulin requirement and urinary albumin excretion. Tacrolimus levels were unaffected at 6 months and modestly decreased at 1 year without compromising graft function. Adverse events were mainly mild gastrointestinal intolerance (10–20%), with rare discontinuations and no increased risk of hypoglycemia, pancreatitis, or infections. Conclusion GLP-1RAs are associated with improved glycemic control, weight, and cardiovascular outcomes, with no consistent signal of adverse effects on graft stability and immunosuppressive balance. GLP-1RA integration into individualized post-transplant care may be considered for patients with diabetes or metabolic syndrome, with close clinical monitoring.
Kanbay et al. (2026) studied this question. GLP-1 receptor agonists significantly reduced major adverse cardiovascular events (OR 0.55) and all-cause mortality (HR 0.53) in kidney transplant recipients.
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