GLP-1 receptor agonists for kidney transplant recipients

Glucagon-like peptide-1 receptor agonists (GLP-1RA) are incretin-based therapies with demonstrated efficacy in glycemic control, weight reduction, and cardiovascular and renal protection. Although data in kidney transplant recipients (KTR) remain limited, the high prevalences of overweight and obesity, post-transplant diabetes mellitus, and cardiovascular disease in this population make GLP-1RAs a promising therapeutic strategy. This narrative review outlines the rationale for their use in KTRs, drawing from recent trials in non-transplant populations and emerging real-world evidence in KTR. We summarize key clinical considerations, including patient selection, dose escalation, and monitoring strategies, as well as existing retrospective and prospective studies examining safety and efficacy in the post-transplant setting. Available data suggest that GLP-1RAs are generally well tolerated, without clear evidence of increased risk for graft rejection, acute pancreatitis, or interaction with immunosuppressive agents. However, gastrointestinal side effects and early discontinuation remain common, emphasizing the need for tailored counseling and dose titration. Importantly, the current evidence is constrained by small sample sizes, short follow-up, and potential selection bias; these limitations lessen the certainty of safety and effectiveness estimates. Translational inferences from non-transplant trials (e.g., SELECT, FLOW, SMART) should also be made cautiously. Future studies should investigate long-term graft outcomes, changes in body composition, and optimal integration with immunosuppressive regimens. A clear research agenda prioritizing graft survival, cardiovascular and kidney outcomes, quality of life, cost-effectiveness, and patient-reported outcomes-ideally via randomized, multicenter or registry-based pragmatic designs-will be critical. As GLP-1RAs become increasingly accessible and clinically relevant, a multidisciplinary and patient-centered approach is essential to guide their safe and effective use in KTRs. This narrative review provides a framework for thoughtful clinical application and highlights areas for future investigation.