#2892 Perioperative dapagliflozin does not associate increased risk of urinary tract infections in incident kidney transplant patients

Abstract Background and Aims Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown promising potential to reduce ischemia-reperfusion injury through multiple potential mechanisms, such as downregulation of inflammation, improved autophagy or regulation of mitochondrial dynamics. Ischemia-reperfusion injury is one of the main drivers of early graft dysfunction after kidney transplantation (KT). As such, SGLT2i could provide renal protection against this type of renal damage. However, their use in the peritransplant period is limited due to the potential risk of increasing the incidence of urinary tract infections (UTI) in immunosuppressed patients. In the present study we aim to compare rates between patients who received SGLT2i in the early peritransplant period vs historical controls. Method Prospective, uncontrolled pilot study of consecutive, incident KT patients that were treated with dapagliflozin 10 mg daily, starting immediately before surgery and continuing until completing the first post-transplant week or graft failure. All patients provided written informed consent. Subjects with liver dysfunction, known allergy to SGLT2i, programmed for live-donor or multiorgan kidney transplantation or unable to provide informed consent were excluded. All patients received a preoperative dose of 2g cefazolin as UTI prophylaxis. The primary outcome was the development of UTI during index hospitalization, defined as either a positive urine culture and/or fever plus other clinical findings suggestive of UTI. For comparison purposes, a retrospective sample of consecutive patients that received a KT prior to the start of this study was selected as the control group. Results Demographic and clinical characteristics of the study sample are summarized in Table 1. Treated patients and controls showed similar rates of UTI (18.8 vs 18.6%, respectively) and prescription of antibiotic therapy for UTI (21.7 vs 20%, respectively). Results of urine cultures and type of administered antibiotic therapy are shown in Fig. 1A and 1B. Conclusion We observed no differences in the incidence of UTI or prescription of antibiotics for UTI between treated patients and controls. In the study sample, perioperative treatment with dapagliflozin associated no increased risk of UTI or prescription of antibiotic therapy due to UTI, compared to historical controls.