Safety of SGLT2 Inhibitors in Kidney Transplant Recipients with Type 2 Diabetes Mellitus (T2DM) or New-Onset Diabetes after Transplant (NODAT): A Single-Centre Experience

Background: Sodium/Glucose Transporter 2 inhibitors (SGLT2i) have demonstrated significant renoprotective effects in native kidney disease. However, evidence of their safety in kidney transplant recipients (KTRs) is lacking. Attention was drawn to the potential increased risk of urinary tract infections (UTIs) in the setting of immunosuppression. We aim to present our local experience on the safety of SGLT2i in KTRs with pre-existing type 2 diabetes mellitus (T2DM) or new-onset diabetes after transplant (NODAT). Methods: A retrospective analysis of 31 KTRs with either pre-existing T2DM or NODAT, who were commenced on SGLT2i, was conducted. Pre-treatment eGFR (estimated glomerular filtration rate) was recorded (using CKD-EPI equation) and further assessed at 6 and 12 months following initiation of SGLT2i. Treatment complications and adverse events were reviewed during the follow-up period. Results: SGLT2i were started for 21/31 (67.7%) KTRs diagnosed with NODAT and 9/31 (29%) with pre-existing T2DM. The median duration of SGLT2i treatment was 23 months (± 12.9). Among 31 KTRs, 5 patients developed uncomplicated UTIs (16%) (Figure 1). eGFR remained stable following SGLT2i initiation with a median value of 62ml/min/1.73m2 (±22.8) pre-treatment and 68 ml/min/1.73m2 (±18.6) 12 months post treatment (Figure 2). One patient developed acute rejection due to non-compliance with immunosuppression. No patient developed euglyceamic diabetic ketoacidosis or genital fungal infections. Conclusion: Our data suggests that SGLT2i are not associated with significant adverse effects. UTIs were the most frequent complications. The incidence, however, is similar to KTRs who were not on SGLT2i as reported in the literature. One of the limitationsof our study is the small sample size, however, we conclude that SGLT2i can be safely prescribed in diabetic KTRs.