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. 2024 Jul;38(7):e15401.
doi: 10.1111/ctr.15401.

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

Elena M Donald  1 , Elissa Driggin  1 , Jason Choe  1 , Jaya Batra  1 , Fabian Vargas  1 , Jordan Lindekens  1 , Justin A Fried  1 , Jayant K Raikhelkar  1 , David J Bae  1 , Kyung T Oh  1 , Melana Yuzefpolskaya  1 , Paolo C Colombo  1 , Farhana Latif  1 , Gabriel Sayer  1 , Nir Uriel  1 , Kevin J Clerkin  1 , Ersilia M DeFilippis  1
Affiliations

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

Elena M Donald et al. Clin Transplant. 2024 Jul.

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.

Keywords: diabetes; glucagon‐like peptide 1; heart transplantation; obesity; weight loss.

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Conflict of interest statement

Conflicts of Interest

Dr. Sayer has received consulting fees and honoraria from Abbott, Dr. Uriel has received grants from Abbott. Dr. DeFilippis is a speaker for Astrazeneca and serves on a clinical trial committee for Abiomed.

Figures

FIGURE 1 |
FIGURE 1 |
Flow diagram of study participants. GI, gastrointestinal; GLP1RA, glucagon like peptide 1 receptor agonist; HT, heart transplant.
FIGURE 2 |
FIGURE 2 |
Box plots for distribution of cardiometabolic parameters pre and post GLP1-RA initiation. Median values are used for NT-proBNP. One outlier with NT-proBNP >10 000 was removed from the diagram. BMI, body mass index (kg/m2); NT-proBNP, N-terminal pro-B-type natriuretic peptide (pg/mL); Cr, creatinine (mg/dL); eGFR, estimated glomerular filtration rate (mL/min/1.73m2); HbA1C, hemoglobin A1C (%); LDL, low density lipoprotein (mg/dL); TG, triglycerides (mg/dL).
See this image and copyright information in PMC

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