Abstract: FR-PO1207
CKD Management After Lung Transplantation: Do SGLT2 Inhibitors Have a Role?
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
- Schamber, Logan Nguyen, University of Florida, Gainesville, Florida, United States
- Ilkun, Olesya, University of Florida, Gainesville, Florida, United States
Background
Patients with chronic kidney disease (CKD) are excluded from lung transplantation (LT) due to worse post-transplant outcomes. Even among patients with normal kidney function, 16% will reach CKD stage 4 within 5 years of LT, and have a 4.5 times higher risk of mortality. Despite this, effective therapies for management of CKD post-LT are not well established.
Methods
This quality improvement initiative aimed to evaluate if sequential initiation of an angiotensin receptor blocker (ARB, losartan or valsartan) and a sodium-glucose cotransporter (SGLT2i, empagliflozin) helps maintain kidney function in LT recipients. Exclusion criteria were cystic fibrosis, frequent urinary tract infections, patients with highly variable creatinine baseline, and those who were within 1 month of LT.
Results
Twelve patients satisfied the study criteria. Mean age was 68.5 years, 66% were male and 33% had diabetes. The patients were on average 4.7 years post-LT. The main reasons for LT were emphysema/COPD (33%) and interstitial lung disease (33%). Mean baseline eGFR was 34.7 ml/min/1.73m2 with albuminuria of 0.112 g/g (0.008-0.292). All patients received a calcineurin inhibitor, 83% tacrolimus and 17% cyclosporine, and 33% were additionally on a mTOR inhibitor. 91% received ARB. All patients received SGLT2i for an average of 588 days (146-1140) at which point their average eGFR was 35.3 ml/min/1.73m2. An example trajectory of creatinine changes on this regimen as compared to body weight is in Figure 1. Two patients transitioned to comfort care due to progressive multiorgan failure. No specific adverse events were observed among other LT recipients who continued receiving SGLT2i.
Conclusion
In our study, the use of SGLT2i in LT recipients with CKD stages 3b-4 was associated with preservation of kidney function. While randomized controlled trials for CKD management in these patients are missing, the use SGLT2i may help maintain kidney function in incident CKD after LT and potentially expand access to LT for patients with pre-existing CKD.