Outcomes of GLP-1 Receptor Agonist Therapy after Liver Transplantation in Patients with Type 2 Diabetes: A Real-World Cohort Study.

BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used to manage type 2 diabetes mellitus (T2DM) in liver transplant (LT) recipients, but their impact on graft outcomes remains unclear. This study evaluated clinical and graft-related outcomes associated with GLP-1 RA therapy. METHODS: We conducted a retrospective cohort study using the TriNetX Network, identifying adults with LT and T2DM. Two cohorts were defined: LT recipients treated with GLP-1 RAs and those receiving conventional antidiabetic therapy. Propensity score matching (1:1) was applied based on demographics, comorbidities, and immunosuppressive regimens. The index date was the first GLP-1 RA prescription within six months before or after LT. Outcomes assessed at one year included all-cause mortality, graft rejection, graft failure, biliary stricture, hepatic artery thrombosis, and transplant-related infections. Analyses used Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS: After matching, 704 patients were included in each cohort. GLP-1 RA use was associated with significantly lower mortality (4.2% vs. 12.6%; HR=0.33, 95%CI: 0.22-0.50; p<0.0001) and reduced risks of rejection (9.0% vs. 15.5%; HR=0.55; p=0.0008), graft failure (7.1% vs. 13.8%; HR=0.50; p=0.0002), biliary stricture (4.1% vs. 6.7%; HR=0.60; p=0.0342), infections (5.7% vs. 10.1%; HR=0.54; p=0.0032), and hepatic artery thrombosis (5.4% vs. 10.7%; HR=0.48; p=0.0007). CONCLUSIONS: GLP-1 RA therapy was associated with improved survival and lower rates of major post-transplant complications, suggesting a potential role as preferred antidiabetic therapy in LT recipients with T2DM.