Early posttransplant GLP-1 agonistic intervention and graft kidney function in transplant recipients with type 2 diabetes

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Early posttransplant GLP-1 agonistic intervention and graft kidney function in transplant recipients with type 2 diabetes

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Co-author 1

Tetsuhiko Sato tetsugar@hotmail.com Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Division of Diabetes and Endocrinology Nagoya Japan *

Co-author 2

Yoshinori Azuma yazuma@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Division of Diabetes and Endocrinology Nagoya Japan -

Co-author 3

Masayoshi Tochiya tetssato@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Division of Diabetes and Endocrinology Nagoya Japan -

Co-author 4

Kenta Futamura kenta88@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Department of Transplant Nephrology Nagoya Japan -

Co-author 5

Yuki Shimamoto yukishimamot@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Department of Transplant Nephrology Nagoya Japan -

Co-author 6

Shunji Narumi nshunji@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Department of Transplant Surgery Nagoya Japan -

Co-author 7

Yoshihiko Watarai watarai@nagoya2.jrc.or.jp Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Department of Transplant Surgery Nagoya Japan -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Diabetic kidney disease could cause graft kidney loss after successful kidney transplantation (KTX), because its immunological alteration may lead posttransplant hyperglycemia and glomerular endothelial dysfunction. Recent evidence shows that GLP-1 receptor agonists reduced the risk of both cardiovascular and kidney-related adverse events in patients living with type 2 diabetes. Furthermore, a retrospective large-scale study has demonstrated that GLP-1receptor agonist use was associated with better graft and patient survival in kidney transplant recipient(KTR)s with preexisting diabetes. The question remains whether early intervention with GLP-1receptor agonists is associated with better graft kidney function.

Methods

The present study was designed to elucidate the possible efficacy of GLP-1 receptor agonist use from as early as week 3 after KTX, evaluating all 140 KTRs with preexisting type 2 diabetes who consecutively underwent KTX in our center between February 2020 and September 2025.

Results

Their age (y), estimated diabetes history (y), posttransplant peak eGFR (mL/min/1.73m2) were 58.2+/-10.6, 15.1+/-8.85, 57.7+/-15.7, (mean +/- SD), respectively. Of those, 75 KTRs were GLP-1 users (duraglutide; 23, liraglutide; 31, semaglutide; 19, tirzepatide; 2), whereas 65 were non-users at week 3 after KTX. The eGFR slope from peak eGFR through week 4, calculated by the least squares mean, were steeper in non-users than in GLP-1 users. These difference between the two groups maintained robustness until month 6 posttransplant.

Conclusion

GLP-1 receptor agonist use as early as week 3 after KTX was associated with better eGFR trajectory. Early posttransplant GLP-1 receptor agonistic intervention may help slow progressive kidney disease and enhance graft kidney survival. Prospective randomized controlled trials are rigorously needed.

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