Abstract: FR-PO1047
One-Year Outcomes of SGLT2 Inhibitors in Kidney Transplant Recipients with Diabetes: A Multicenter Italian Cohort Study
Session Information
- Transplantation: Clinical - Pharmacology and Nonkidney Solid Organ Transplants
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Alfieri, Carlo, Universita degli Studi di Milano, Milan, Lombardy, Italy
- Troise, Dario, Azienda Ospedaliera Universitaria Foggia, Foggia, Apulia, Italy
- Menegotto, Alberto, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Lombardy, Italy
- Delfrate, Nicholas Walter, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Orsi, Emanuela, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Grancini, Valeria, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Resi, Veronica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Molinari, Paolo, Universita degli Studi di Milano, Milan, Lombardy, Italy
- Minetti, Enrico Eugenio, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Lombardy, Italy
- Stallone, Giovanni, Azienda Ospedaliera Universitaria Foggia, Foggia, Apulia, Italy
- Castellano, Giuseppe, Universita degli Studi di Milano, Milan, Lombardy, Italy
Background
The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in kidney transplant recipients (KTRs) remains an area of active investigation. This multicenter Italian study aimed to evaluate the safety and efficacy of SGLT2i treatment in diabetic KTRs over a 12-month period.
Methods
Sixty-five diabetic KTRs (mean age 59±11 years, 66% male) from 3 Italian transplant centers (Policlinico and Niguarda Hospitals Milan, and Policlinico of Foggia) were enrolled. Primary nephropathies included glomerulonephritis (41%), ADPKD (13%), and diabetic nephropathy (9%). Pre-transplant diabetes was present in 25%, history of steroid use in 14%, and cardiovascular disease in 49%. All patients were on antidiabetic and immunosuppressive therapy, typically including steroids, calcineurin inhibitors, and mycophenolate. Dapagliflozin was used in 70% of cases, empagliflozin in the remainder. Clinical and biochemical parameters (renal function, glucose and lipid metabolism, uric acid, proteinuria, BMI, blood pressure) were assessed at baseline (T0), and at 3, 6, 9, and 12 months (T12). Analyses included descriptive stats, paired comparisons (T0 vs T12), and fixed-model analysis.
Results
At baseline, mean creatinine was 1.54±0.62 mg/dL, eGFR 52.3±16.2 mL/min/1.73m2, proteinuria 0.4±0.3 g/24h, BMI 29.9±5.3 kg/m2, and weight 75±21 kg. Paired comparisons from T0 to T12 demonstrated significant reductions in BMI (29.9±5.3 to 28.5±4.8 kg/m2; p=0.041), serum uric acid (6.5±1.6 to 5.7±1.4 mg/dL; p=0.005), and diastolic blood pressure (80.9±8.9 to 78.7±7.9 mmHg; p=0.029). Fixed-model analyses revealed a significant time-dependent reduction in serum uric acid (p=0.019). Renal function (creatinine and eGFR) and glucose parameters did not exhibit statistically significant variations over time. Therapy was generally well tolerated, with urinary tract infections observed only in five patients at 12 months as the only drug-related adverse events.
Conclusion
SGLT2 inhibitors demonstrated good safety and beneficial metabolic and cardiovascular effects in diabetic KTRs, particularly regarding BMI, serum uric acid, and diastolic blood pressure. These findings support the potential long-term benefits of SGLT2i in the transplant population.