A NEW US-based study has found that GLP-1 receptor agonists, a class of medications originally developed for type 2 diabetes, may offer significant survival and graft-protective benefits for kidney transplant recipients with diabetes.
The large retrospective cohort study analysed data from over 18,000 patients with type 2 diabetes who received a kidney transplant between 2013 and 2020. Of these, 1,969 patients (10.9%) began using GLP-1 receptor agonists after their transplant.
Researchers found that use of GLP-1 receptor agonists was associated with a 49% lower risk of graft loss (adjusted subhazard ratio [aSHR] 0.51) and a 31% reduction in mortality (adjusted hazard ratio [aHR] 0.69) compared to non-users. Importantly, these benefits persisted even after accounting for differences in age, sex, comorbidities, and other potential confounders.
In matched cohorts, the 5-year cumulative incidence of death-censored graft loss was 6.0% among GLP-1 users versus 10.7% in non-users, and mortality was 17.0% vs 25.8%, respectively.
While GLP-1 receptor agonists have already been shown to reduce cardiovascular and renal risk in the general population with diabetes, this study is among the first to show similar benefits in the high-risk population of kidney transplant recipients, who often have longer disease duration and multiple complications.
Safety outcomes were generally reassuring, with no increased risks observed for most adverse effects, although an increased risk of diabetic retinopathy (aHR 1.49) was noted.
“These findings suggest GLP-1 receptor agonists could offer substantial benefits for a vulnerable group of patients,” the authors noted. However, they also emphasised the need for randomised clinical trials to confirm these real-world observations.
Aleksandra Zurowska, EMJ
Reference
Orandi B et al. GLP-1 receptor agonists in kidney transplant recipients with pre-existing diabetes: a retrospective cohort study. Lancet Diabetes Endocrinol. 2025;DOI: 10.1016/S2213-8587(24)00371-1.
