S2600 SGLT-2 Inhibitors: A Game Changer for Cirrhosis? Examining Mortality, Hepatocellular Cancer, and Liver Transplantation Rates

Introduction: Cirrhosis is a chronic liver condition characterized by progressive hepatic dysfunction and complications, including the need for liver transplantation. Emerging evidence suggests that sodium-glucose cotransporter-2 (SGLT-2) inhibitors, originally developed for managing type 2 diabetes, may offer benefits in patients with cirrhosis. This study aims to provide insights into the impact of SGLT-2 therapy on key clinical outcomes, including liver transplantation, hepatocellular carcinoma (HCC), and all-cause mortality. Methods: We conducted a retrospective analysis using deidentified, aggregate patient data from the TriNetX research network. The cohort comprised patients ≥18 years old with a diagnosis of cirrhosis. Patients who commenced SGLT-2 inhibitors after the diagnosis of cirrhosis were identified. Primary outcomes included liver transplantation, HCC, and all-cause mortality. Variables such as age, sex, race, comorbidities (e.g., diabetes, obesity, chronic kidney disease, hypertension), and lifestyle factors (e.g., tobacco use, alcohol dependence) underwent 1:1 propensity matching to reduce confounding. Odds ratios (OR) with 95% confidence intervals (CI) were reported for the matched cohorts. Results: The matched cohort analysis demonstrated a significant reduction in the necessity for liver transplantation (OR 0.666, 95% CI 0.542–0.818) and all-cause mortality (OR 0.321, 95% CI 0.304–0.340) among patients receiving SGLT-2 inhibitors. Furthermore, a noteworthy decrease in the incidence of hepatocellular carcinoma was observed (OR 0.933, 95% CI 0.859–1.013), highlighting the potential protective effects of SGLT-2 therapy in this patient population. These findings underscore the clinical significance of SGLT-2 inhibitors in improving outcomes for individuals with cirrhosis. Conclusion: This study provides solid evidence that using SGLT-2 inhibitors is associated with reduced the need for liver transplantation and lowers all-cause mortality in cirrhosis patients. Furthermore, the observed decrease in hepatocellular carcinoma incidence implies that SGLT-2 inhibitors may have a preventive impact, underscoring their value in cirrhosis therapy. These findings emphasize the necessity to consider SGLT-2 therapy as a vital component in maximizing patient outcomes and enhancing the overall care of cirrhosis patients.