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Abstract: PO2124

SGLT-2 Inhibitor Treatment in Renal Transplant Recipients: A Single-Center Experience

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Liriano-Ward, Luz E., Montefiore Medical Center, Bronx, New York, United States
  • Stefan, Simona, Montefiore Medical Center, Bronx, New York, United States
  • Campbell, Alesa, Montefiore Medical Center, Bronx, New York, United States
  • Al Azzi, Yorg, Montefiore Medical Center, Bronx, New York, United States
  • Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
  • Pynadath, Cindy T., Montefiore Medical Center, Bronx, New York, United States
  • Loarte Campos, Pablo, Montefiore Medical Center, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Bronx, New York, United States
Background

Dapagliflozin, a sodium glucose transport protein 2 inhibitor (SGLT2-i), was recently approved for use in chronic kidney disease patients regardless of the presence of diabetes, after studies demonstrated improved renal and cardiovascular outcomes even in the absence of diabetes. The use of SGLT2-i in transplant recipients have been limited due to concerns for acute kidney injury (AKI) resulting from volume depletion or urinary tract infections (UTI) or other genital infections due to their glucosuric effect.

Methods

Retrospective review of all adult renal transplant recipients transplanted at our center between January 2013 and June 2020.

Results

22 adult renal transplant patients at our center received treatment with an SGLT2-i during the study period. The patient’s ethnicity was representative of our patient’s population with 45% being Hispanic and 40% black. 68% of the patients were men and the median age was 64 years old. The vast majority of patients, 77%, had diabetes mellitus as the etiology of ESRD. 73% received a deceased donor kidney transplant and were started on SGLT2-i at a median time of 38 months post-transplant. 13 patients were treated with empagliflozin with a starting dose of 10mg daily, 7 with canagliflozin at 100mg daily, 1 dapagliflozin at 5mg daily, and 1 ertugliflozin at 2.5mg daily. The median creatinine at the start of treatment was 1.1mg/dl, urine protein creatinine ratio was 206 mg/g, and A1C 8.6 %. SGLT2-inhibitors were well tolerated without significant adverse events. 4 patients developed hypoglycemia. Two patients developed a UTI and only 1 patient developed AKI requiring discontinuation of the drug. The median creatinine one-year post treatment initiation was stable at 1.1mg/dl, UPCR was 448.4 mg/g, and A1C was 7.7. Finally, there was no significant interaction with the immunosuppression medications. The tacrolimus level remained stable and the patients did not require dose modifications post therapy initiation.

Conclusion

Treatment with SGLT2-i was well tolerated in our transplant population. Larger prospective studies are required to evaluate clinical outcomes in this patient population.