Effects of SGLT2 inhibitors on transplant survival and key clinical outcomes in heart transplant recipients with diabetes.

Abstract

Background: Chronic kidney disease and heart allograft vasculopathy are the primary causes of morbidity and mortality after cardiac transplant. This study aimed to evaluate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on transplant survival, cardiovascular events, dialysis, and all-cause mortality in diabetes patients who have undergone heart transplantation.

Methods: In this research, we adopted data from the TriNetX collaborative network to observe outcomes in patients who underwent heart transplants between January 01, 2015 and December 31, 2022. A total of 6494 transplant recipients were identified, from which 1063 matched pairs of SGLT2i users and non-users were selected using propensity score matching. The Kaplan-Meier analysis and Cox proportional hazards models were applied to compare the risks of various outcomes between the study and control groups.

Results: In propensity-matched cohorts, patients using SGLT2i exhibited a lower risk of dialysis [hazard ratio (HR) (95% confidence interval [CI]): 0.566 (0.385-0.833)], graft rejection and failure [0.873 (0.774-0.985)], hospitalizations [0.822 (0.739-0.916)], and all-cause death [0.767 (0.627-0.938)] compared to non-users. Yet, no significant differences were observed between the two groups in the risks of post-transplant infection or sepsis [0.891 (0.739-1.075)], ischemic heart disease (HR: 1.044, 95% CI: 0.939-1.161), and heart failure worsening [0.915 (0.733-1.144)].

Conclusion: This multicenter cohort study demonstrated that cardiac transplant recipients with diabetes who received SGLT2i had a significantly lower risk of dialysis, graft rejection, hospitalization, and all-cause mortality compared to those who did not receive SGLT2i.