SGLT2 inhibitors found to significantly reduce rejection risk in patients with diabetes undergoing heart transplantation. The findings from a meta-analysis based on eight studies including 2,755 participants and evaluated the impact of the drug class on post-heart transplantation outcomes in patients with pre-existing diabetes, a group known to be at increased risk of graft failure and mortality.
Use of SGLT2 inhibitors in heart transplant findings target unmet risk
Rejection remains a major post-transplant complication in patients with end-stage heart disease. Previously, researchers have identified that pre-existing diabetes mellitus is present in 30% of patients who undergo heart transplantation – a population associated with greater rates of mortality and graft failure.
While SGLT2 inhibitors are long established in glycaemic control, interest has grown in whether metabolic therapies could complement traditional post-transplant management.
Rejection risk reduced in patients taking SGLT2 inhibitors
Wang and the research team conducted a meta-analysis of eight studies, totalling 2,755 participants. They found that there was a lower risk of rejection in patients taking SGLT2 inhibitors (RR: 0.85, 95% CI: 0.78-0.93; P = 0.0001). However, no significant difference was found in mortality, sepsis, weight/BMI, serum creatinine, eGFR, HbA1c improvement following transplantation. The researchers highlighted that rejection reduction emerged as the principal signal despite neutral findings across other outcomes.
Questions around broader post-transplant outcomes
While SGLT2 inhibitors were associated with a reduced risk of rejection in this analysis, no significant differences were observed in mortality or other assessed clinical outcomes. The authors noted that due to their pleiotropic effects, the inhibitors may offer benefits including cardiorenal and potentially immunomodulatory effects. The authors also emphasised that further studies are needed to better address the impact on other key post-transplant outcomes, including survival.
Reference
Wang H et al. Impact of SGLT2 inhibitors on clinical outcomes in patients with diabetes mellitus following heart transplantation: a meta-analysis. Diabetes Ther. 2026;DOI:10.1007/s13300-026-01866-4.
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