Sodium-Glucose Co-Transporter-2 Inhibitors and Cardiovascular Effects in Kidney Transplant Recipients With Diabetes Mellitus.

OBJECTIVES

Sodium-glucose co-transporter-2 inhibitors (SGLT2is) reduce major adverse cardiovascular events and mortality in patients with type 2 diabetes mellitus, but kidney transplant recipients (KTRs), a high-risk group, were excluded from major trials. We aimed to evaluate the association between SGLT2i use and cardiovascular outcomes in KTRs with diabetes.

METHODS

In this retrospective matched-cohort study at a large transplant center, KTRs with diabetes treated with SGLT2i were compared to matched controls receiving other antihyperglycemic agents. Major outcomes were: (1) a composite of acute coronary syndrome, stroke/transient ischemic attack, or all-cause mortality; and (2) a composite of heart failure hospitalizations (hHFs) or all-cause mortality.

RESULTS

A total of 480 patients (240 per group; 20% women; median age 63-64 years) were included. Treatment with SGLT2i was started 5.9 years (IQR 2.0-13.9) after the transplant surgery, and patients were followed for up to 3 years. The incidence of acute coronary syndrome, stroke/transient ischemic attack, or death was 7.9 vs 13.6 events per 100 person-years in the SGLT2i and control groups, respectively (adjusted hazard ratio 0.64, 95% confidence interval 0.42-0.97, P = .039). HHFs or death occurred less frequently in SGLT2i users (5.7 vs 11.6 events per 100 person-years), though the difference was not statistically significant after adjustment (hazard ratio 0.82, 95% confidence interval 0.50-1.32, P = .410).

CONCLUSIONS

SGLT2i use was associated with lower rates of major cardiovascular events in KTRs with diabetes, without a significant reduction in hHF. Given the elevated cardiovascular risk in KTRs, these findings support further investigation of SGLT2i therapy in this population.