Tirzepatide in solid organ transplant recipients: Early real-world signals of efficacy and safety-A narrative review.

Post-transplant metabolic management remains challenging, as immunosuppression exacerbates diabetes and obesity, threatening graft outcomes. While incretin-based therapies have transformed metabolic care, data on tirzepatide-a dual GIP/GLP-1 receptor agonist-in solid organ transplantation (SOT) are scarce. This review synthesizes early real-world evidence on tirzepatide's efficacy and safety in this high-risk population. A structured search of major databases identified 10 eligible reports; however, quantitative synthesis was restricted to the 6 studies (n = 182 recipients) providing disaggregated tirzepatide data. In this specific subset, tirzepatide demonstrated robust metabolic efficacy, with HbA1c reductions of 0.6-1.4 percentage points and weight loss of 5.5-6.9 kg. Crucially, renal parameters remained stable, with one study noting a modest eGFR increase (+3 mL/min/1.73 m2) and another reporting significant proteinuria reduction. Tacrolimus trough levels showed minimal fluctuation (Δ -0.2 to +0.2 ng/mL), suggesting no clinically significant pharmacokinetic interaction. Adverse events were predominantly gastrointestinal and manageable, with no signals of acute rejection or graft dysfunction. Despite limitations inherent to retrospective data and small sample sizes, preliminary evidence suggests tirzepatide is a potent strategy for cardiometabolic optimization in SOT, offering significant benefits without compromising graft function. These promising signals warrant confirmation in prospective, multicenter trials to definitively establish safety and long-term outcomes.