Safety and Effectiveness of GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Liver Transplant Recipients with Diabetes.

BACKGROUND: We studied the safety and effectiveness of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT2is) in liver transplant recipients with diabetes. METHODS: This retrospective single-center study included 41 patients treated with GLP1-RAs and/or SGLT2is after liver transplantation (LT) who were compared to a control group receiving antidiabetic treatment excluding GLP1-RAs and/ SGLT2is. RESULTS: The treatment group showed no serious adverse events, with 15.0% experiencing moderate side effects, primarily gastrointestinal disorders. The HbA1c target concentration was achieved in 90.0% (n=36) of patients in the GLP1-RA and/or SGLT2i group versus 74.0% (n = 42) in the control-group (p = 0.16). The fasting glycaemia target was reached by a higher proportion of patients in the GLP1-RA and/or SGLT2i group than in the control-group: 80.0% versus 55.0%, p = 0.033. Insulin withdrawal was greater in the group of patients receiving GLP1-RAs and/or SGLT2is treatment, in particular for those with post-transplant diabetes (80.0% vs. 0%, p < 0.01). The median time of follow-up was 11.0 months (IQR: 6-13). CONCLUSIONS: Our results suggest the safety of GLP1-RAs and SGLT2is treatment, with the remarkable benefit of insulin withdrawal for a subgroup of patients with new-onset diabetes. However, larger prospective studies are needed to assess the long-term impact on cardiovascular events, obesity, liver steatosis, and mortality.