SGLT2 Inhibitors as Nephroprotective Agents in Kidney Transplant Recipients: A Narrative Review

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have gained interest for their glycemic control and are now being investigated for cardiorenal benefits. This non-systematic literature review evaluates current evidence on the use and effects of SGLT2 inhibitors in kidney transplant recipients (KTR). A narrative literature search of PubMed/MEDLINE and Embase was conducted; publications reporting SGLT2 inhibitor use in adult KTR were included: randomized controlled trials, systematic reviews or meta-analyses, and multiple prospective and retrospective cohort studies. Included studies in this review report associations between SGLT2 inhibitor use and renal, cardiovascular, and metabolic outcomes, including lower rates of adverse cardiovascular events, improved glycemic control, reduced body mass index, blood pressure reduction confined to hypertensive recipients, and stable short-term allograft function. Because this data is predominantly observational, with modest sample sizes and follow-up frequencies, causal inference is not warranted and nephroprotective efficacy in this population remains unestablished. Further research and additional randomized controlled trials are needed to better understand the long-term effects of SGLT2 inhibitors in post-renal transplant patients.