Uso de los agonistas del receptor del péptido similar al glucagón tipo 1 en pacientes trasplantados renales

Abstract

IntroductionIn kidney transplant (KT) recipients, diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacking evidence in KT recipients. ObjectiveTo analyze the efficacy and safety of glucagon-like peptide 1 receptor GLP1-RA in a cohort of KT recipients. MethodsMulticenter retrospective cohort study of KT patients with DM who started subcutaneous GLP1-RA in three hospitals in the province of Cádiz between February 2016 and July 2022. Estimated glomerular filtration rate (eGFR), proteinuria, and weight at baseline and after 6 and 12 months were collected. We analyzed glycemic control, blood pressure, lipid profile, and doses and trough levels of tacrolimus. We document episodes of acute rejection (AR), de novo donor-specific antibodies (dnDSA), and adverse effects. ResultsDuring this period, 96 KT with DM started treatment with GLP1-RA, of which 84 had a minimum follow-up of 6 months and 61 were followed for 12 months. A significant reduction was observed in proteinuria (−19.1 mg/g, P = .000; −46.6 mg/g, P = .000), weight (−3.6 kg, P = .000; −3.6 kg, P = .000), glycosylated hemoglobin (−0.7%, P = .000; −0.9%, P = .000), systolic blood pressure (−7.5 mmHg, P = .013; −7.3 mmHg, P = .004), total cholesterol (−11.5 mg/dl, P = .001; −15.6 mg/dl, P = .002) and LDL cholesterol (−9.2 mg/dl, P = .002; −16.8 mg/dl, P = .000) at 6 months and 1 year of follow-up. The eGFR remained stable and the dose and trough levels of tacrolimus did not change. No episodes of AR or development of dnDSA were observed during follow-up. ConclusionsGLP1-RA in KT patients can be a safe and effective option for the management of DM in KT.