SGLT2 Inhibitors and GLP-1 Receptor Agonists in Kidney Transplantation: A Systematic Review and Meta-Analysis.
Lee, S. A., et al.Transplantation. 2026 Jan 1;110(1):e217-e228.
Aims
This study aimed to provide an updated summary of the available evidence on the role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in kidney transplant recipients.
Interventions
Electronic databases searched included Embase, MEDLINE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Studies were selected by two independent reviewers. The Cochrane Risk of Bias 2 (RoB2) tool and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool were used to assess the methodological quality of the included studies, for randomised controlled trials and observational studies respectively.
Participants
32 studies were included in the review.
Outcomes
The main outcomes of interest were mortality (all-causes), adverse cardiovascular and kidney events, surrogate efficacy parameters and safety outcomes.
Follow-up
N/A
CET Conclusions
This systematic review and meta-analysis summarises 32 studies using SGLT2 inhibitors or GLP-1 receptor agonists (GLP1RA) in kidney transplant recipients. Use of these agents promoted weight loss, reduced mortality and improved cardiovascular and kidney outcomes, with no increase in adverse events. The analysis includes a mixture of randomised controlled trials and retrospective and prospective cohort studies with variable risk of bias. Due to heterogeneity in the included studies not all outcomes were amenable to meta-analysis, with descriptive analysis used for mortality, cardiovascular and renal outcomes (focussing on adjusted analyses). Where meta-analysis is used, heterogeneity is very high, which is perhaps unsurprising giving the variable patient populations and different drugs used. Overall, the existing literature appears to support the conclusion that use of these agents is safe in kidney transplant recipients, with some evidence of benefit. Future high-quality randomised controlled trials are needed to further define the benefits and aid patient selection.
Trial registration
PROSPERO - CRD42025630101