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Cited by 73Diabetes Treatment and ManagementRenal Transplantation Outcomes and TreatmentsDiabetes Management and Research

The use of GLP1R agonists for the treatment of type 2 diabetes in kidney transplant recipients

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Kukla, Aleksandra, Hill, Jennifer, Merzkani, Massini, Bentall, Andrew, Lorenz, Elizabeth C., Park, Walter D., D’Costa, Matthew, Kudva, Yogish C. +2 more·2020·Transplantation Direct
DOI 10.1097/txd.0000000000000971PMC PMC7004635
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Abstract

Background.: Glucagon-like peptide-1 receptor agonists (GLP1RA) have been shown to improve glucose control and diabetes-related comorbidities in patients without solid organ transplants. The effectiveness, safety, and tolerability of GLP1RA after kidney transplantation have not been adequately studied. Methods.: We retrospectively reviewed data on kidney transplant recipients performed in our institution, who were initiated on GLP1RA either for the treatment of type 2 diabetes diagnosed before transplantation or posttransplant diabetes. We analyzed efficacy, safety, and the effect on kidney allograft function. Results.: Seventeen kidney transplant recipients were initiated on GLP1RA therapy, 14 of which remained on the medication for at least 12 months. The use of GLP1RA had no significant impact on weight loss, but was associated with a significant reduction in the total daily insulin dose, from the median of 63 [interquartile range 43-113] IU to 44 [interquartile range 25-88] and reduction in the risk of hypoglycemia in patients who were on therapy for at least approximately 12 months. Kidney function remained stable and none of the recipients experienced acute rejection. Tacrolimus dose was not significantly changed. Five patients (29%) discontinued GLP1RA therapy—4 due to side effects and 1 due to uncontrolled hyperglycemia. Conclusions.: GLP1RA may be a relatively safe and effective treatment for kidney transplant recipients with type 2 diabetes that allows for a reduction in insulin requirements. More studies are needed to determine whether the use of these agents will translate into an improvement in allograft and patient survival.

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  • Studies have not found evidence of drug interaction between GLP-1 RAs and immunosuppression, including no changes in dosing or toxicity.

    “Studies have not found evidence of drug interaction with immunosuppression, including finding no changes in dosing or toxicity (231-233).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [232]

    The Results and Discussion (page unavailable) report no significant change in tacrolimus dosing and no acute rejection after GLP-1RA initiation; the authors infer no clinically significant effect on tacrolimus absorption. The paper does not establish an absence of interactions or toxicity across immunosuppressive drugs, and it notes that gastrointestinal side effects of mycophenolate and GLP-1RAs may be cumulative. (LLM, conf=0.84)

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Cited by

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Authors
Kukla, A., Hill, J., Merzkani, M., Bentall, A., Lorenz, E. C., Park, W. D., D’Costa, M., Kudva, Y. C., Stegall, M. D., & Shah, P.
Affiliations
Mayo Clinic (US)
Corresponding author
Kukla, Aleksandra
ORCID
Venue
Transplantation Direct
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-01-13
Volume
6
Issue
2
Pages
e524
ISSN
2373-8731 (ISSN-L)
DOI
10.1097/txd.0000000000000971
PMC
PMC7004635
OpenAlex
W2999068538
Cited by
73
References
11
Citations by year
2026: 6 · 2025: 17 · 2024: 19 · 2023: 12 · 2022: 7 · 2021: 10 · 2020: 2
FWCI
5.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Transplantation Direct (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK123313)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
GLP-1 receptor agonists, type 2 diabetes, kidney transplantation, post-transplant diabetes mellitus, insulin dose reduction, hypoglycemia, kidney allograft function, tacrolimus, drug safety and tolerability, weight loss

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