Safety and Effectiveness of GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Liver Transplant Recipients with Diabetes - 06/08/26

Doi : 10.1016/j.clinre.2026.102899

Alessandra Mazzola ^1,^⁎ , Philippe Sultanik ¹, Aida Rebiha ¹, Raluca Pais ¹, Dominique Thabut ^1,², Olivier Scatton ^2,³, Olivier Bourron ^4,^5,^{⁎
Filomena Conti and Olivier Bourron contributed equally to this work.}, Filomena Conti ^1,^{⁎
Filomena Conti and Olivier Bourron contributed equally to this work.}

¹ Sorbonne Université, Unité Médicale de Transplantation Hépatique Service d’Hépato gastroentérologie AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris France.

² Sorbonne Université, INSERM, Centre de Recherche de Saint –Antoine (CRSA).

³ Sorbonne Université, Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, AP-HP, Hôpital Pitié-Salpetrière, 75013, Paris France.

⁴ Sorbonne Université, Service de Diabétologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.

⁵ UMRS_1166, INSERM, Paris, France.

^$ Corresponding author.

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Highlight

•	Available data on GLP-1 RAs and SGLT-2 inhibitors use in LT recipients are limited.
•	90.0% of LT recipients with diabetes achieved HbA1c target with GLP-1RA/SGLT2i.
•	Treatment was well tolerated, with moderate adverse events reported in 15.0% of patients.
•	Gastrointestinal disorders occur in 8.5% of patients.

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Abstract

Background

We studied the safety and effectiveness of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT2is) in liver transplant recipients with diabetes.

Methods

This retrospective single-center study included 41 patients treated with GLP1-RAs and/or SGLT2is after liver transplantation (LT) who were compared to a control group receiving antidiabetic treatment excluding GLP1-RAs and/ SGLT2is.

Results

The treatment group showed no serious adverse events, with 15.0% experiencing moderate side effects, primarily gastrointestinal disorders. The HbA1c target concentration was achieved in 90.0% (n=36) of patients in the GLP1-RA and/or SGLT2i group versus 74.0% (n = 42) in the control-group (p = 0.16). The fasting glycaemia target was reached by a higher proportion of patients in the GLP1-RA and/or SGLT2i group than in the control-group: 80.0% versus 55.0%, p = 0.033. Insulin withdrawal was greater in the group of patients receiving GLP1-RAs and/or SGLT2is treatment, in particular for those with post-transplant diabetes (80.0% vs. 0%, p < 0.01). The median time of follow-up was 11.0 months (IQR: 6-13).

Conclusions

Our results suggest the safety of GLP1-RAs and SGLT2is treatment, with the remarkable benefit of insulin withdrawal for a subgroup of patients with new-onset diabetes. However, larger prospective studies are needed to assess the long-term impact on cardiovascular events, obesity, liver steatosis, and mortality.

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Keywords : new-onset diabetes, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, glycemic control, insulin withdrawal

Plan

Introduction

Method

Study design and participants

Descriptive data of the participants

Informed consent and patient details

Studies in Human

CRediT authorship contribution statement

Alessandra Mazzola, Sorbonne Université, Unité médicale de transplantation hépatique, APHP-Pitié-Salpêtrière. 43-87 Boulevard de l’hôpital. Phone: +33771235019