MON-170 OUTCOMES OF SGLT2 INHIBITORS USE IN DIABETIC RENAL TRANSPLANT PATIENTS- SINGLE CENTER EXPERIENCE

Abstract

New-onset diabetes after transplantation (NODAT) is common among renal transplant patients. The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in non-transplant diabetic patients with cardiovascular (CV) disease has well established efficacy and safety. It has long term renal protective effects in patients with impaired kidney function. Data regarding the safety and long term efficacy of SGLT2 inhibitors use in diabetic renal transplant patients is lacking. We report our experience with use of SGLT2 inhibitors in diabetic renal transplant patients. A retrospective chart review study was conducted at our institution over 2 years from 6 /2016 until 10/2018. We included all diabetic transplant patients who were started on SGLT2 inhibitors. Demographic, clinical and laboratory data were collected and analyzed using descriptive analysis. Complications related to use of SGLT2 inhibitors were monitored. a total of 8 renal transplant patients were included, two patients (25%), had long standing diabetes mellitus type 2 and six patients (75%) had post-transplant diabetes (NODAT). The majority were males (75%), with mean age of 56.8 years. The co-morbid conditions in our cohort were hypertension (7 [87.5 %]), dyslipidemia (7 [87.5%]), history of urinary tract infection (2 [25%]) and obesity ( body mass index ) BMI > 30 (4 [50%]). Median years from transplantation were 9.6 years and all patients had transplant from living unrelated donors, with stable allograft function (eGFR >60). The immunosuppressant medications used were tacrolimus (62.5%), cyclosporine (37.5%), prednisolone (100%), and mycophenolate (62.5%), mycophenolic acid (37.5%) and all patients were maintained on triple therapy regime. The median baseline HbA1c was 9.3 and hypoglycemic medications used including; metformin (37.5%), gliclazide modified release (62.5%), DPP4 inhibitors (37.5%), insulin (37.5%), and dulaglutide 1.5 mg q wk (37.5%). SGLT2 inhibitors (empagliflozin (6), dapagliflozin (2)) were added for diabetic transplant patients for better glycemic control that was noted with minor reduction of HbA1c at 3 and 6 months in some patients. The renal graft functions were stable with use of SGLT2 inhibitors without any acute kidney injury event and there was minor reduction of weight. Incidence of acute urinary tract infections were low (1) and no reported fungal infections. The two patients who had previous history of UTI did not experience recurrent episodes, except one patient developed one episode of UTI after 1 year of SGLT2 use. SGLT2 inhibitors were well tolerated. diabetic renal transplant patients with stable kidney function and CKD stage I or II (eGFR>60), had slightly better glycemic control with use of SGLT2 inhibitors. There was no deterioration of kidney function and risk of recurrent UTI was low. Further studies are needed to explore the long term safety and efficacy of SGLT2 inhibitors in diabetic renal transplant patients.