Impact of Glucagon-like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors on Post–liver Transplant New-onset Major Adverse Cardiovascular Events, Graft Failure, Renal Outcome, and Mortality

Background. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, but there are little data in solid organ transplant populations. We aimed to assess the effect of GLP-1 RA or SGLT2i on the incidence of post-transplant major adverse cardiovascular events (MACE), graft failure, renal outcomes, and mortality in liver or simultaneous liver-kidney transplant populations. Methods. A retrospective chart review of adults with diabetes mellitus and either solitary liver or simultaneous liver-kidney transplantation from January 2012 to March 2022 was completed. The multivariate Cox regression and Fine and Gray competing risk regression analyses were used. Results. Among 457 patients, 33 received a GLP-1 RA or SGLT2i. The GLP-1 RA/SGLT2i group had a lower incidence of graft failure ( P = 0.038), new-onset end-stage renal disease requiring dialysis ( P = 0.012), and new-onset post–liver transplant MACE at 5 y (adjusted subdistribution hazard ratio, 0.24; P = 0.049; 95% confidence interval, 0.059-0.99). Conclusions. After propensity score matching, the incidence of 5-y post–liver transplant MACE-free survival was significantly higher, and mortality was significantly lower in the GLP-1 RA/SGLT2i group. The use of a GLP-1 RA/SGLT2i post–liver transplant was associated with a lower incidence of new-onset MACE, graft failure, and new-onset end-stage renal disease requiring dialysis. There was an improvement in survival after propensity score matching.