New systematic review of 7012 kidney transplant recipients with T2D finds GLP-1 receptor agonists cut major adverse kidney events and mortality by 61%.
A new systematic review of 7012
The data were presented in a late-breaking poster at the
“Although GLP-1 RAs are well established in the general diabetic population, evidence in transplant recipients is still limited,” Montejano and colleagues wrote.
These findings align with broader momentum behind GLP-1 RAs in chronic kidney disease (CKD) care, following semaglutide's landmark 2025 approval for kidney disease in patients with T2D, a shift clinicians say has already reshaped treatment guidelines across endocrinology, nephrology, and cardiology.
Unlike insulin and sulfonylureas, GLP-1 receptor agonists stimulate insulin release only when blood glucose is elevated, a mechanism associated with reduced hypoglycemia risk in the general diabetic population.2
Montejano and colleagues conducted a systematic review per PRISMA guidelines, using PubMed, BVS, and Cochrane databases, with the ROBINS-I tool for bias assessment.
In total, investigators identified 7012 kidney transplant recipients treated with liraglutide, dulaglutide, exenatide, or semaglutide, with follow-up ranging from 24 months to 3.1 years.
Upon analysis, investigators observed an HbA1c reduction of −0.5% ± 1.3% with GLP-1 RA therapy compared with −0.1% ± 0.8% with control (P = .01). MAKE occurred in 12.3% of GLP-1 RA users versus 20.3% of controls (adjusted Hazard Ratio [aHR], 0.66; 95% Confidence Interval [CI], 0.58–0.75), while all-cause mortality was 2.6% versus 9.0% (aHR, 0.39; 95% CI, 0.31–0.50). Gastrointestinal side effects, primarily nausea and vomiting, were modestly increased with GLP-1 RA therapy (aHR, 1.21; 95% CI, 1.02–1.45), with no corresponding increase in severe events such as hypoglycemia or pancreatitis.
“Despite promising results, these agents remain underutilized,” investigators concluded. “Future research studies are needed to confirm these findings, define optimal therapeutic approaches, assess drug-drug interactions, and guide clinical practice.”
