Abstract: FR-PO1036
Effect of Metformin Use on Graft and Patient Survival in Kidney Transplant Recipients with Diabetes: A Systematic Review
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
- Tungsanga, Somkanya, University of Alberta, Edmonton, Canada
- Shamshad, Farooq, University of Alberta, Edmonton, Alberta, Canada
- Shojai, Soroush, University of Alberta, Edmonton, Alberta, Canada
- Ghimire, Anukul, University of Calgary, Calgary, Alberta, Canada
- Ye, Feng, University of Alberta, Edmonton, Alberta, Canada
- Okpechi, Ikechi G., University of Alberta, Edmonton, Alberta, Canada
- Bello, Aminu K., University of Alberta, Edmonton, Alberta, Canada
Background
Metformin is a widely used antihyperglycemic agent in diabetes, but its role in kidney transplant recipients (KTR) remains uncertain due to concerns about safety and unclear impact on clinically meaningful outcomes. We conducted a systematic review to evaluate the effect of metformin on graft and patient survival in KTRs.
Methods
We systematically searched five databases (inception–April 2023) for studies evaluating metformin use in adult KTRs with type-2 diabetes mellitus (T2DM) or post-transplant diabetes mellitus (PTDM). Observational and interventional studies reporting graft failure or all-cause mortality were included. Risk of bias was assessed using ROBINS-I tool. Adjusted hazard ratios (aHR) were pooled using multilevel random-effects models.
Results
Three observational cohort studies met inclusion criteria, encompassing 48,909 KTRs, including 18,113 living donor and 30,787 deceased donor transplants. Of these, 5,802 were metformin users and 43,107 were non-users. Metformin use was associated with a significantly lower risk of graft failure (aHR 0.48 [95% CI: 0.32–0.71], p<0.001; Figure 1A) and all-cause mortality (aHR 0.58 [95% CI: 0.34–1.00], p=0.049; Figure 1B) at one-year post-transplant. Safety outcomes, such as lactic acidosis or acute kidney injury, were underreported.
Conclusion
Metformin use is associated with lower graft failure and mortality benefit in KTRs with diabetes. However, findings are based on observational data, and safety outcomes remain underreported. Further studies with robust designs are needed.
Adjusted hazard ratios of metformin use for (A) graft failure and (B) all-cause mortality at one-year post-transplant