Cardio-Renal-Metabolic Outcomes Associated With the Use of GLP-1 Receptor Agonists After Heart Transplantation

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-07-18 DOI:10.1111/ctr.15401

Elena M. Donald, Elissa Driggin, Jason Choe, Jaya Batra, Fabian Vargas, Jordan Lindekens, Justin A. Fried, Jayant K. Raikhelkar, David J. Bae, Kyung T. Oh, Melana Yuzefpolskaya, Paolo C. Colombo, Farhana Latif, Gabriel Sayer, Nir Uriel, Kevin J. Clerkin, Ersilia M. DeFilippis

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Abstract

Background

The use of glucagon-like-peptide 1 receptor agonists (GLP1-RA) has dramatically increased over the past 5 years for diabetes mellitus type 2 (T2DM) and obesity. These comorbidities are prevalent in adult heart transplant (HT) recipients. However, there are limited data evaluating the efficacy of this drug class in this population. The aim of the current study was to describe cardiometabolic changes in HT recipients prescribed GLP1-RA at a large-volume transplant center.

Methods

We retrospectively reviewed all adult HT recipients who received GLP1-RA after HT for a minimum of 1-month. Cardiometabolic parameters including body mass index (BMI), lipid panel, hemoglobin A1C, estimated glomerular filtration rate (eGFR), and NT-proBNP were compared prior to initiation of the drug and at most recent follow-up. We also evaluated for significant dose adjustments to immunosuppression after drug initiation and adverse effects leading to drug discontinuation.

Results

Seventy-four patients were included (28% female, 53% White, 20% Hispanic) and followed for a median of 383 days [IQR 209, 613] on a GLP1-RA. The majority of patients (n = 56, 76%) were prescribed semaglutide. The most common indication for prescription was T2DM alone (n = 33, 45%), followed by combined T2DM and obesity (n = 26, 35%). At most recent follow-up, mean BMI decreased from 33.3 to 31.5 kg/m² (p < 0.0001), HbA1C from 7.3% to 6.7% (p = 0.005), LDL from 78.6 to 70.3 mg/dL (p = 0.018) and basal insulin daily dose from 32.6 to 24.8 units (p = 0.0002).

Conclusion

HT recipients prescribed GLP1-RA therapy showed improved glycemic control, weight loss, and cholesterol levels during the study follow-up period. GLP1-RA were well tolerated and were rarely associated with changes in immunosuppression dosing.

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心脏移植后使用 GLP-1 受体激动剂的心肾代谢结果

背景：过去 5 年来，胰高血糖素样肽 1 受体激动剂（GLP1-RA）的使用急剧增加，主要用于治疗 2 型糖尿病（T2DM）和肥胖症。这些合并症在成年心脏移植（HT）受者中十分普遍。然而，评估该类药物在这一人群中疗效的数据非常有限。本研究的目的是描述在一个大容量移植中心服用 GLP1-RA 的心脏移植受者的心脏代谢变化：方法：我们回顾性研究了所有成年 HT 受者，他们在 HT 后接受 GLP1-RA 治疗至少 1 个月。我们比较了开始用药前和最近一次随访时的心血管代谢参数，包括体重指数（BMI）、血脂组合、血红蛋白 A1C、估计肾小球滤过率（eGFR）和 NT-proBNP。我们还评估了用药后对免疫抑制的重大剂量调整以及导致停药的不良反应：74名患者（28%为女性，53%为白人，20%为西班牙裔）接受了中位数为383天[IQR为209-613]的GLP1-RA随访。大多数患者（n = 56，76%）的处方为塞马鲁肽。最常见的处方适应症是单纯 T2DM（33 人，占 45%），其次是合并 T2DM 和肥胖（26 人，占 35%）。在最近的随访中，平均体重指数从 33.3 kg/m2 降至 31.5 kg/m2 （p < 0.0001），HbA1C 从 7.3% 降至 6.7% （p = 0.005），低密度脂蛋白从 78.6 mg/dL 降至 70.3 mg/dL （p = 0.018），基础胰岛素日剂量从 32.6 单位降至 24.8 单位（p = 0.0002）：结论：在研究随访期间，接受 GLP1-RA 治疗的高血糖患者的血糖控制、体重减轻和胆固醇水平均有所改善。GLP1-RA的耐受性良好，而且很少会引起免疫抑制剂量的变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.