Abstract: FR-OR083
Clinical Effectiveness of SGLT2 Inhibitors in Nondiabetic Kidney Transplant Recipients: A Real-World Data Analysis
Session Information
- The Changing Landscape of Kidney Transplantation: Clinical Innovation, Outcomes, and Health Policy
October 23, 2026 | Location: Mile High Ballroom 4A, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Schmidt, Bernhard M.W., Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Tran, Jamila-Cate, Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Tian, Zhejia, Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Willerding, Jonas Michael, Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Casper, Janis, Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Schmidt-Ott, Kai M., Medizinische Hochschule Hannover, Hanover, NDS, Germany
- Melk, Anette, Medizinische Hochschule Hannover, Hanover, NDS, Germany
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established therapies for slowing chronic kidney disease (CKD) progression, but evidence regarding their use in non-diabetic kidney transplant recipients is scarce. This study investigated the clinical effectiveness of SGLT2i in this underrepresented population, evaluating their association with major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality.
Methods
We conducted a retrospective cohort study using the TriNetX federated health research platform. The study included adult, non-diabetic patients who received their first kidney transplant between January 2015 and January 2022. Using 1:1 propensity score matching based on 46 covariates, we compared transplant recipients who initiated SGLT2i therapy at least 1,000 days post-transplant with unexposed controls. The primary outcome was MAKE (a composite of dialysis initiation or death), while secondary outcomes included all-cause mortality and MACE.
Results
Propensity score matching yielded 867 balanced pairs of SGLT2i users and non-users. SGLT2i therapy was associated with a significantly lower hazard of MAKE (adjusted hazard ratio [aHR] 0.64, 95% CI: 0.45-0.91). All-cause mortality was also markedly reduced in the SGLT2i group (aHR 0.55, 95% CI: 0.36-0.85). No statistically significant difference was observed for MACE (aHR 0.86, 95% CI: 0.64-1.17). Competing risk analyses demonstrated that numerical increases in some individual non-fatal cardiovascular outcomes within the SGLT2i cohort were largely attributable to survivorship bias. Safety analyses indicated no increased risk of urinary tract infections among SGLT2i users.
Conclusion
SGLT2i use in non-diabetic kidney transplant recipients is associated with a substantial reduction in MAKE and all-cause mortality, alongside a favorable safety profile without an increased risk of genitourinary infections. These findings suggest that SGLT2 inhibitors have considerable potential to improve long-term renal outcomes and survival in this specific patient population.