Abstract: FR-PO1202
Prescription Patterns of SGLT2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors in Kidney Transplant Recipients: A Real-World Analysis
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Shehata, Michael, Oregon Health & Science University, Portland, Oregon, United States
- Vang, Ginseng, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Patel, Rima, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Johnson, Carli J., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Thomas, Beje S., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Hanna, Paul, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Background
Kidney transplant recipients (KTRs) have a high cardiometabolic burden but were excluded from trials establishing the cardiovascular and renal benefits of SGLT2 inhibitors (SGLT2i), GLP-1 receptor agonists (GLP-1 RA), and DPP-4 inhibitors (DPP-4i). Real-world prescribing patterns in KTRs have not been characterized.
Methods
Using the TriNetX federated network, we identified 59,176 KTRs with ≥6 months of post-transplant follow-up, excluding patients with poor follow-up, multi-organ transplants, or prior bariatric surgery. A 6-month post-transplant landmark was used as time zero to avoid immortal time bias. New prescriptions were defined as the first outpatient orders after the landmark, with no use in the prior 6 months. Comorbidities were ascertained from the full pre-transplant record using ICD-9 and ICD-10 codes. MV log regression identified independent predictors of new SGLT2i prescriptions.
Results
Our cohort was 60% male, mean age 52±15 years; 43% had diabetes, 43% ASCVD, 19% heart failure, and 25% obesity. Overall, 13.2%, 5.0%, and 1.8% received new SGLT2i, GLP-1 RA, and DPP-4i prescriptions after landmark, respectively. Annual new SGLT2i rates rose from 0.44% in 2019 to 3.46% in 2024, with an inflection following the 2020–2021 FDA label expansions for heart failure and CKD (Fig. 1A). Prescription rates were highest in patients with concurrent diabetes, heart failure, and obesity (33.1%, SMD >30%; Fig. 1B). On mv analysis, diabetes (OR 2.55, 95% CI 2.41–2.70), ASCVD (OR 1.69, 1.60–1.79), obesity (OR 1.69, 1.60–1.78), and heart failure (OR 1.49, 1.41–1.58) were each independently associated with new SGLT2i prescriptions. Hispanic patients were less likely (OR 0.92, 0.85–1.00) and Asian patients more likely (OR 1.20, 1.08–1.33) to receive SGLT2i vs. Non-Hispanic White recipients. Among SGLT2i users, 95.5% of GLP-1 RA users took both, suggesting a highly selected subgroup.
Conclusion
SGLT2i, GLP-1 RA, and DPP-4i prescribing in KTRs has increased substantially since 2020, is indication-driven, and reveals meaningful racial disparities. These data establish a prescribing baseline in this vulnerable population as prospective trials emerge.