Sodium glucose cotransporter 2 inhibitors are associated with renal stabilization in heart transplantation

Sodium glucose cotransporter 2 inhibitors (SGLT2i) are standard of care for type 2 diabetes mellitus, heart failure, and chronic kidney disease (CKD). Heart transplant (HTx) recipients are at increased risk of diabetes and CKD, and both are independently associated with increased mortality. In a retrospective analysis of 104 HTx recipients with diabetes (23 exposed to SGLT2i, 81 not exposed), SGLT2i treatment was associated with stable renal function at 3 years post-HTx, measured by estimated glomerular filtration rate change from baseline (median change of 0 ml/min/1.73 m² (interquartile range [IQR] -13 to +11)), compared to a change of -15 ml/min/1.73 m² (IQR -27 to +1) in patients not exposed to SGLT2i (<i>p</i> = 0.02). There was no significant difference in survival by SGLT2i exposure, adjusted for diabetes type and baseline creatinine (hazard ratio 0.34, confidence intervals 0.11-1.06, <i>p</i> = 0.06). Further investigation of SGLT2i in HTx recipients, particularly focusing on renal outcomes, is required.