Diabetes mellitus is a well-known complication of solid organ transplant (SOT).To date,there is scant published literature and no consensus guidelines pertinent to management of diabetes in transplant recipients.The aim of our study was to examine the efficacy and safety of a GLP-1 agonist, Liraglutide, in this patient population.
We performed a retrospective chart review of adult SOT recipients (>18 years age) with diabetes being treated with Liraglutide.We identified 25 recipients and collected data at 6,12 and 24 months post Liraglutide therapy.The primary endpoint was:change in weight, BMI, and insulin requirement.Safety endpoints included rate of cardiovascular mortality,hypoglycemia,GI side-effects,and cancers.Secondary endpoints were:HbA1c, renal and liver function.
There was a trend of reduction in weight, BMI, and insulin requirement at each study point, but these results were not statistically significant. Percentage decrease in weight was 0.09%, 0.87% and 0.89%; and in BMI was 0.24%,1.4%, and 0.54% at 6,12 and 24 months respectively. The mean insulin reduction pre, and post Liraglutide was 4.74 units (3.6% reduction).There was a trend of decrease of HbA1c at the 6 and 12 month mark, but this was not seen at 24 month study point.24% of patients had nonsevere hypoglycemia and 16% had mild GI adverse effects, none requiring discontinuation of medications.1 patient had non-fatal stroke,and 3 patients had anginal episodes, two of which also had non-fatal MI.These 4 patients had pre-existing cardiovascular disease.There was no mortality.One patient had kidney graft failure unrelated to Liraglutide use.There was no increased incidence of pancreatitis, transaminitis or cancer.Immunosuppressive agents remained unchanged.
Our single-center study in SOT recipients demonstrated safety of Liraglutide,a GLP-1 agonist,in this patient population.Cardiovascular morbidity was only seen in 4 patients who had pre-existing cardiovascular disease.There was no other significant organ damage (kidney, liver) or interference with immunosuppressants.The side-effect profile (minimal GI side-effects and no severe hypoglycemia) was tolerable.Our data also suggested beneficial effects of Liraglutide in the reduction of weight, BMI and insulin dose,though these outcomes were not statistically significant, likely due to small sample size.
Conclusion : Our study demonstrated safety of Liraglutide in SOT recipients, though benefical effects on weight and HbA1C were not statistically significant.Further larger retrospective studies or prospective randomized trials in transplant patients are warranted to determine the efficacy and safety of GLP-1 agonists in transplant patients
The Ohio State University
Clinical Fellow in training
The Ohio State University
Member of the Endocrine Society
Member of the Islet Transplant Selection Committee at Ohio State
Medical Student Liaison for Endocrinology at Ohio State
Transplant Endocrinologist at Ohio State’s Comprehensive Transplant Center
Rated in the top 10 percent of physicians in the nation for patient satisfaction, 2017