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Cited by 41Renal Transplantation Outcomes and TreatmentsChronic Kidney Disease and DiabetesDiabetes Treatment and Management

Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: a retrospective analysis of integrated registry and pharmacy claims data

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Vest, L. S., Koraishy, F. M., Zhang, Z., Lam, N. N., Schnitzler, M. A., Dharnidharka, V. R., Axelrod, D., Naik, A. S. +4 more·2018·Clinical Transplantation
DOI 10.1111/ctr.13302PMC PMC6122956
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Abstract

While guidelines support metformin as a therapeutic option for diabetic patients with mild‐to‐moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008‐2015). Associations (adjusted hazard ratio, 95% LCL aHR 95% UCL) of diabetes regimens (with and excluding metformin) in the first year post‐transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use. Among 14 144 recipients with pretransplant type 2 diabetes mellitus, 4.7% filled metformin in the first year post‐transplant; most also received diabetes comedications. Compared to those who received insulin‐based regimens without metformin, patients who received metformin were more likely to be female, have higher estimated glomerular filtration rates, and have undergone transplant more recently. Metformin‐based regimens were associated with significantly lower adjusted all‐cause (aHR 0.18 0.41 0.91), malignancy‐related (aHR 0.45 0.45 0.99), and infection‐related (aHR 0.12 0.32 0.85) mortality, and nonsignificant trends toward lower cardiovascular mortality, graft failure, and acute rejection. No evidence of increased adverse graft or patient outcomes was noted. Use of metformin‐based diabetes treatment regimens may be safe in carefully selected kidney transplant recipients.

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  • Metformin use may be associated with lower all-cause, malignancy-related, and infection-related mortality after kidney transplantation.

    “Metformin use may be associated with lower risks of cardiac allograph vasculopathy after heart transplantation (229) and all-cause, malignancy-related, and infection-related mortality after kidney transplantation (230).”

    From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [230]

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Authors
Vest, L. S., Koraishy, F. M., Zhang, Z., Lam, N. N., Schnitzler, M. A., Dharnidharka, V. R., Axelrod, D., Naik, A. S., Alhamad, T. A., Kasiske, B. L., Hess, G. P., & Lentine, K. L.
Affiliations
  • Saint Louis University (US)
  • University of Alberta (CA)
  • Washington University in St. Louis (US)
  • Lahey Hospital and Medical Center (US)
  • University of Michigan (US)
  • Hennepin County (US)
  • Symphony Health Conshohocken PN USA
Corresponding author
Lentine, K. L.
ORCID
Venue
Clinical Transplantation
Publisher
Wiley
Published
2018-06-29
Volume
32
Issue
8
Pages
e13302-e13302
ISSN
  • 0902-0063 (ISSN-L)
  • 1399-0012
DOI
10.1111/ctr.13302
PMC
PMC6122956
OpenAlex
W2807310966
Cited by
41
References
4
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 7 · 2019: 3
FWCI
3.21
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Transplantation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK102981)
Topics
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
metformin, kidney transplantation, type 2 diabetes, post-transplant diabetes mellitus, insulin therapy, graft survival, patient survival, graft failure, acute rejection, mortality, drug safety, renal failure
MeSH terms
Adolescent, Adult, Child, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection, Graft Survival, Humans, Hypoglycemic Agents, Insurance, Pharmaceutical Services, Kidney Failure, Chronic, Kidney Function Tests, Male, Metformin, Middle Aged, Postoperative Complications, Prognosis, Registries, Retrospective Studies, Risk Factors, United States, Survival Rate, Kidney Transplantation, Young Adult, Transplant Recipients

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