Glucagon-like Peptide-1 Receptor Agonists in Heart Transplant Recipients With Type 2 Diabetes: A Multicenter Study

BACKGROUND: Type 2 diabetes mellitus (T2DM) is frequent after heart transplantation (HT) and is exacerbated by immunosuppressive therapy. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve metabolic control, but data in HT recipients are limited. METHODS: We performed a retrospective, multicenter study including HT recipients with T2DM from 14 Spanish centers. In patients treated with GLP-1 RAs, we assessed antidiabetic and immunosuppressive therapies, adverse events, and changes in metabolic parameters, insulin dose, and immunosuppressant trough levels during the first year after GLP-1 RA initiation. RESULTS: Among 734 HT recipients with T2DM (2011-2021), 108 (14.7%) received GLP-1 RAs (mean age 55.4 ± 9.0 y; 79.6% male), initiated 4.0 ± 3.1 y post-HT. At baseline, 64.8% had obesity. Semaglutide was used in 59%, dulaglutide in 27%, liraglutide in 13%, and tirzepatide in 1%; 41.7% achieved the maximum therapeutic dose. After 1 y, significant reductions were observed in body weight (-6.2 kg; 95% confidence interval [CI], -7.7 to -4.5 kg), fasting glucose (-27 mg/dL; 95% CI, -41 to -7 mg/dL), glycated hemoglobin (-0.74%; 95% CI, -1.12% to -0.35%), total cholesterol (-12 mg/dL; 95% CI, -19 to -6 mg/dL), low-density lipoprotein cholesterol (-8 mg/dL; 95% CI, -14 to -2 mg/dL), triglycerides (-29 mg/dL; 95% CI, -53 to -5 mg/dL), and systolic blood pressure (-3.6 mm Hg; 95% CI, -6.4 to -0.9 mm Hg). Tacrolimus trough levels decreased modestly (-0.7 ng/mL; 95% CI, -1.4 to -0.1 ng/mL; P = 0.025), without episodes of acute rejection. Gastrointestinal adverse events occurred in 12.0%, leading to discontinuation in 3.7%. CONCLUSIONS: In HT recipients with T2DM, GLP-1 RAs were associated with improved glycemic and cardiometabolic parameters and were generally well tolerated. These findings support the use of GLP-1 RAs as a valuable therapeutic strategy for the management of T2DM after HT.

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Transplantation
Published
2026-10-27
DOI
https://doi.org/10.1097/tp.0000000000005945
Primary Topic
Diabetes Treatment and Management
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article

Glucagon-like Peptide-1 Receptor Agonists in Heart Transplant Recipients With Type 2 Diabetes: A Multicenter Study

Zorba Blázquez‐Bermejo, Julia Martínez Solé, Gonzalo Cabezón Villalba, María del Val Groba Marco et al.
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Transplantation
Diabetes Treatment and Management
article

Glucagon-like Peptide-1 Receptor Agonists in Heart Transplant Recipients With Type 2 Diabetes: A Multicenter Study

Zorba Blázquez‐Bermejo, Julia Martínez Solé, Gonzalo Cabezón Villalba, María del Val Groba Marco, Elena García‐Romero, Cristina Daniela Mitroi, Clara Simón-Ramón, Daniel Enríquez-Vázquez, Iris Paula Garrido, Ana Marcén Miravete, Carlos Ortiz‐Bautista, Iris Maria Esteve Ruiz, Beatriz Díaz Molina, María Angeles Castel, Andrea Severo
article en

Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) is frequent after heart transplantation (HT) and is exacerbated by immunosuppressive therapy. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve metabolic control, but data in HT recipients are limited. METHODS: We performed a retrospective, multicenter study including HT recipients with T2DM from 14 Spanish centers. In patients treated with GLP-1 RAs, we assessed antidiabetic and immunosuppressive therapies, adverse events, and changes in metabolic parameters, insulin dose, and immunosuppressant trough levels during the first year after GLP-1 RA initiation. RESULTS: Among 734 HT recipients with T2DM (2011-2021), 108 (14.7%) received GLP-1 RAs (mean age 55.4 ± 9.0 y; 79.6% male), initiated 4.0 ± 3.1 y post-HT. At baseline, 64.8% had obesity. Semaglutide was used in 59%, dulaglutide in 27%, liraglutide in 13%, and tirzepatide in 1%; 41.7% achieved the maximum therapeutic dose. After 1 y, significant reductions were observed in body weight (-6.2 kg; 95% confidence interval [CI], -7.7 to -4.5 kg), fasting glucose (-27 mg/dL; 95% CI, -41 to -7 mg/dL), glycated hemoglobin (-0.74%; 95% CI, -1.12% to -0.35%), total cholesterol (-12 mg/dL; 95% CI, -19 to -6 mg/dL), low-density lipoprotein cholesterol (-8 mg/dL; 95% CI, -14 to -2 mg/dL), triglycerides (-29 mg/dL; 95% CI, -53 to -5 mg/dL), and systolic blood pressure (-3.6 mm Hg; 95% CI, -6.4 to -0.9 mm Hg). Tacrolimus trough levels decreased modestly (-0.7 ng/mL; 95% CI, -1.4 to -0.1 ng/mL; P = 0.025), without episodes of acute rejection. Gastrointestinal adverse events occurred in 12.0%, leading to discontinuation in 3.7%. CONCLUSIONS: In HT recipients with T2DM, GLP-1 RAs were associated with improved glycemic and cardiometabolic parameters and were generally well tolerated. These findings support the use of GLP-1 RAs as a valuable therapeutic strategy for the management of T2DM after HT.

Transplantation
Universidad Complutense de Madrid (ES), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitari i Politècnic La Fe (ES), Research Institute Hospital 12 de Octubre (ES), Institut d'Investigació Biomédica de Bellvitge (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Hospital Universitario 12 De Octubre (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Universitario Miguel Servet (ES), Centro de Investigación Biomédica en Red (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario Central de Asturias (ES), Complexo Hospitalario Universitario A Coruña (ES), Hospital Universitario Virgen de la Arrixaca (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Clínico Universitario de Valladolid (ES), Instituto de Investigación Biomédica de A Coruña (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Institut de Recerca Sant Pau (ES), Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (ES), Instituto de Investigación Sanitaria Gregorio Marañón (ES), Universitat de Barcelona (ES)
Good health and well-being
Openalex Percentile: Top 11%
Diabetes Treatment and Management
DOISourceOpenAlex
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