Efficacy and Safety of Sodium–Glucose Cotransporter 2 Inhibitors on Solid Organ Transplant Recipients with Diabetes—A Systematic Review and Meta-analysis

Ratan P., Kodalak S., Saldarriaga L., Andrade A. D., Ferreira R., Trevisan T.

American Diabetes Association 85th Scientific Sessions, Illinois, United States Of America, 21 - 23 June 2025, pp.897, (Full Text)

  • Publication Type: Conference Paper / Full Text
  • City: Illinois
  • Country: United States Of America
  • Page Numbers: pp.897
  • Hacettepe University Affiliated: Yes

Abstract

Introduction and Objective: Diabetes mellitus is a common complication after solid organ transplant (SOT). Sodium-glucose cotransporter inhibitors (SGLT2i) have shown significant cardio-renal benefits in people with type 2 diabetes. However, their use in SOT recipients remains underexplored in the existing literature. We aimed to perform a systematic review and meta-analysis to evaluate the efficacy and safety of SGLT2i in SOT recipients with diabetes.

Methods: PubMed, EMBASE, Cochrane Central, and clinicaltrials.gov were systematically searched for studies using SGLT2i in SOT recipients with diabetes. We computed mean difference (MD) and standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using Comprehensive Meta-analysis version 3.3.070.

Results: Of 1817 identified studies, data from 18 eligible studies containing 5092 participants were pooled. On meta-analysis, SGLT2i was associated with significantly lower glycated hemoglobin (HbA1c) (SMD: −0.36; 95% CI: −0.59, −0.16; p<0.01; I2=90.4%), and body weight (MD: −2.35 kg; 95% CI: −3.0, −1.67; p<0.001; I2=39.3% ) while no difference was noted in estimated glomerular filtration rate. Adverse cardiovascular events were reduced in SGLT2i users (RR: 0.38; 95% CI: 0.25, 0.57; p<0.001; I2= 0%) whereas there was no significant risk of genitourinary infections. There was significant heterogeneity for HbA1c and weight, attributable to population-specific factors, such as time since transplant and concomitant therapies (as glucagon-like peptide 1 receptor agonists).

Conclusion: In SOT recipients with diabetes, SGLT2i therapy may be associated with better glycemic control and reduced body weight, presenting an acceptable safety profile and an optimized care.