Introduction:
GLP-1 receptor agonists (GLP-1 RAs), initially developed for glycemic control in diabetes, have gained recognition for their multifaceted therapeutic roles, including benefits in obesity, heart failure with preserved ejection fraction (HFpEF), coronary artery disease (CAD), and proteinuria. Their popularity has surged among patients with elevated BMI, particularly those awaiting kidney transplants. These agents not only inhibit gastric emptying and suppress appetite but also affect cholecystokinin release, potentially leading to bile stasis and increased cholecystitis risk. A meta-analysis published in 2022 highlighted a notable rise in biliary and gallbladder diseases associated with GLP-1 RA use.
Methods:
We present a case involving a 37-year-old female with a history heterozygous Factor V Leiden mutation, obesity, polycystic ovary syndrome (PCOS), hypertension, migraines and end-stage renal disease (ESRD) due to oxalate nephropathy, who underwent a living unrelated donor kidney transplant. Semaglutide (initially 0.25 mg, escalated to 0.5 mg) was initiated 6 months prior to transplant, following which the patient had a weight loss of 10-15 kg to be transplant eligible. She received induction immunosuppression with Thymoglobulin with a rapid steroid taper and maintenance immunosuppression with mycophenolate and tacrolimus was initiated on post op day 2. She had experienced immediate graft function and was discharged on postoperative day 3. One week post-transplant, she was admitted with acalculous gangrenous cholecystitis without systemic bacteremia or identifiable sources of bacterial seeding to gallbladder. Initial management included conservative treatment with antibiotics, temporary suspension of Semaglutide and cholecystostomy tube placement, followed by cholecystectomy six weeks later. Given the absence of an identifiable source for the cholecystitis, it was attributed to bile stasis from GLP-1 RA use, especially considering her recent weight loss and the higher dosage.
Results:
Our findings align with a meta-analysis by Liyun He et al., which indicated an increased incidence of biliary tract disease in patients using GLP-1 RAs for obesity and type 2 diabetes, particularly with higher doses and recent weight loss. The initiation of immunosuppression in the perioperative period may heighten the risk of infectious complications, such as acalculous cholecystitis.
Conclusions:
In conclusion, the increased incidence of biliary tract disease associated with GLP-1 RA use necessitates heightened awareness among healthcare providers, particularly for patients undergoing kidney transplants. A low threshold for suspicion of biliary infections should be maintained in these cases. Further studies are warranted to explore the relationship between GLP-1 RA therapy and biliary tract disease in the early post-transplant period.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.
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