Efficacy and safety of empagliflozin in the management of diabetes mellitus in heart transplant recipients
Open accessAbstract
Background.: Type 2 diabetes mellitus (T2DM) is prevalent in patients undergoing heart transplant, and in those without preexisting T2DM, posttransplant diabetes mellitus may develop. Both T2DM and posttransplant diabetes mellitus have been associated with increased morbidity and mortality following heart transplantation. Empagliflozin is an effective glucose-lowering therapy that reduces the incidence of major cardiovascular events in patients with T2DM. The safety and efficacy of empagliflozin in transplant patients with diabetes mellitus has yet to be established. Methods.: Clinical outcomes were retrospectively examined in 22 heart transplant recipients treated with empagliflozin and compared with those of 79 heart transplant patients with diabetes mellitus receiving alternative glucose-lowering therapies. Results.: Three adverse events were recorded in empagliflozin-treated patients, leading to treatment discontinuation in 1. There were no genitourinary infections. Treatment with empagliflozin for 12 months was associated with reductions in weight, body mass index, glycated hemoglobin, and frusemide dose that were not seen in the control group. There were no large changes observed in blood pressure (systolic or diastolic) or renal function (serum urea, creatinine, or estimated glomerular filtration rate) after 12 months of treatment with empagliflozin or alternative glucose-lowering therapies. Conclusions.: Empagliflozin appears safe and effective in the management of selected patients with diabetes mellitus following heart transplantation.
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For T2D and posttransplant diabetes, it is reasonable to treat kidney transplant recipients with metformin according to eGFR, as for the broader population with T2D, because risks of metformin are related to kidney function.
“For T2D and posttransplant diabetes, it is reasonable to treat kidney transplant recipients with metformin according to eGFR, as for the broader population with T2D, because risks of metformin are related to kidney function (80–84).”
From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [81]
The Results and Discussion (page numbers unavailable) mention metformin use among heart transplant recipients, but do not address metformin treatment in kidney transplant recipients. Searches for metformin with eGFR, renal function, and contraindications found no guidance on eGFR-based metformin use or evidence that its risks depend on kidney function. (LLM, conf=0.76)
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- Authors
- Cehic, M. G., Muir, C. A., Greenfield, J. R., Hayward, C., Jabbour, A., Keogh, A., Kotlyar, E., Muthiah, K., & Macdonald, P. S.
- Affiliations
- Victor Chang Cardiac Research Institute (AU)
- Garvan Institute of Medical Research (AU)
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
- Corresponding author
- Macdonald, Peter S.
- ORCID
- Venue
- Transplantation Direct
- Published
- 2019-05
- Volume
- 5
- Issue
- 5
- Pages
- e450
- ISSN
- 2373-8731 (ISSN-L)
- PMC
- PMC6511439
- OpenAlex
- W2940695156
- Cited by
- 55
- References
- 19
- Citations by year
- 2026: 11 · 2025: 8 · 2024: 10 · 2023: 5 · 2022: 8 · 2021: 9 · 2020: 4
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Transplantation Direct (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- empagliflozin, heart transplantation, type 2 diabetes, post-transplant diabetes mellitus, SGLT2 inhibitors, glucose-lowering therapy, HbA1c, weight loss, renal function, drug safety, adverse events
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