Effect of dapagliflozin in liver transplant recipients with chronic kidney disease

• Dapagliflozin preserved eGFR in liver transplant recipients with CKD • Dapagliflozin significantly reduced albuminuria (UACR) in this population. • Renal benefit persisted in patients with severely impaired eGFR (≤30 ml/min). • Favorable safety profile with no serious adverse events or drug interactions. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have gained significant attention in clinical research due to their diverse therapeutic effects. The aim of this retrospective study was to analyze the nephroprotective effects of SGLT2i on kidney function in patients experiencing renal insufficiency after liver transplantation. A retrospective study was conducted comparing 43 liver transplant recipients with chronic kidney disease treated with dapagliflozin and 43 controls, who attended the LMU University Hospital between 2020 and 2023. Changes in estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), liver parameters, and safety outcomes were assessed. Dapagliflozin administration was associated with preservation of renal function demonstrated by stable eGFR values (p=0.05), while the control cohort experienced significant deterioration in kidney function (p=0.03). The nephroprotective effect persisted in patients with severely reduced baseline GFR (≤30 ml/min; p=0.08). Moreover, dapagliflozin significantly reduced UACR (p=0.04), with enhanced renal protection observed in patients with severe albuminuria, diabetes (p=0.08), and those receiving calcineurin inhibitor therapy (p=0.12). The incidence of transient eGFR decline (>10% decrease within 4 weeks, followed by recovery) was observed in 9 patients (20.9%) treated with dapagliflozin, while sustained progressive kidney dysfunction (>10% eGFR decline persisting at final follow-up) occurred significantly more frequently in controls (46.5%; p=0.001). One urinary tract infection was documented in the dapagliflozin group during the observation period. No treatment discontinuations due to serious adverse events occurred. Dapagliflozin improves renal outcomes in liver transplant recipients with chronic kidney disease and has a favorable safety profile. Prospective trials are needed to confirm these findings.