B144 - One-Year Outcomes of SGLT2 Inhibitors in Diabetic Kidney Transplant Recipients: A Multicenter Italian Cohort Study

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Author Block: C. Alfieri¹, D. Troise², A. Menegotto³, N. Del Frate⁴, M. Righi¹, E. Minetti³, G. Castellano¹, ¹University of Milan, Milan, Italy, ²University of Foggia, Foggia, Italy, ³Niguarda Hospital, Milan, Italy, ⁴Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milano, Italy
*Purpose: The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in kidney transplant recipients (KTRs) remains an area of active investigation. This multicenter Italian study aimed to evaluate the safety and efficacy of SGLT2i treatment in diabetic KTRs over a 12-month period.
*Methods: Sixty-five diabetic KTRs (mean age 59±11 years, male 66%) from three Italian transplant centers (Policlinico and Niguarda Hospital, in Milan and Policlinico of Foggia) were enrolled. Primary nephropathies included glomerulonephritis (41%), autosomal dominant polycystic kidney disease (13%), and diabetic nephropathy (9%). Pre-transplant diabetes was present in 25%, history of steroid treatment in 14%, and cardiovascular disease in 49%. All patients had previously received antidiabetic treatment and immunosuppressive therapy, mostly including steroids, calcineurin inhibitors, and mycophenolate. Dapagliflozin was administered in 70% of patients, with empagliflozin in the remaining. Clinical and biochemical parameters (renal function, glucose and lipid metabolism, uric acid, proteinuria, BMI, blood pressure) were assessed at baseline (T0) and at 3, 6, 9, and 12 months (T12) of treatment. Statistical analyses included population descriptive statistics, paired comparisons (T0 vs T12), and fixed-model analyses.
*Results: At baseline, mean creatinine was 1.54±0.62 mg/dL, eGFR 52.3±16.2 mL/min/1.73m², proteinuria 0.4±0.3 g/24h, BMI 29.9±5.3 kg/m², and weight 75±21 kg. Paired comparisons from T0 to T12 demonstrated significant reductions in BMI (29.9±5.3 to 28.5±4.8 kg/m²; p=0.041), serum uric acid (6.5±1.6 to 5.7±1.4 mg/dL; p=0.005), and diastolic blood pressure (80.9±8.9 to 78.7±7.9 mmHg; p=0.029). Fixed-model analyses revealed a significant time-dependent reduction in serum uric acid (p=0.019). Renal function (creatinine and eGFR) and glucose parameters (glycemia and HbA1c) did not exhibit statistically significant variations over time. Therapy was generally well tolerated, with urinary tract infections observed only in five patients at 12 months as the only drug-related adverse events.
*Conclusions: SGLT2 inhibitors demonstrated good safety and beneficial metabolic and cardiovascular effects in diabetic KTRs, particularly regarding BMI, serum uric acid, and diastolic blood pressure. These findings support the potential long-term benefits of SGLT2i in the transplant population.