Safety, tolerability and efficacy of GLP-1 receptor agonists (GLP-1 RA) in the management of post-liver transplant weight gain: A multicenter, observational study.

Background subcutaneous semaglutide was most used at a median dose of 0.82±0.46 mg weekly. Treatment led to significant reductions in body weight (-3.8 kg; -3.9%, p<0.001), body mass index (BMI) (-1.6 kg/m2; -5.0%, p<0.001), and glycated hemoglobin (HbA1c) (-0.48%, p=0.002), with modest lipid improvement. Liver function tests and immunosuppression trough levels remained stable, and no treatment-limiting adverse events occurred. In matched analyses (80 GLP-1 RA users vs. 116 non-users), GLP-1 RAs facilitated greater weight loss (-3.4 kg difference, p=0.009) and HbA1c reduction (-0.43% difference in HbA1c, p=0.042) without increased risk of allograft dysfunction, T-cell-mediated rejection (TCMR) or MACE.Conclusions This multicenter, international study demonstrates GLP-1 RAs are safe and moderately effective in reducing weight and improving metabolic parameters post-LT, without adverse effects on allograft function or immunosuppression, despite limitations of low dosing. Prospective, randomized trials of GLP-1 RAs in LTRs are thus warranted.