Elsevier

Transplantation Proceedings

Volume 50, Issue 8, October 2018, Pages 2502-2505
Transplantation Proceedings

15th Congress of the Asian Society of Transplantation
Renal transplantation
Management of Diabetes Mellitus With Glucagonlike Peptide-1 Agonist Liraglutide in Renal Transplant Recipients: A Retrospective Study

https://doi.org/10.1016/j.transproceed.2018.03.087Get rights and content

Highlights

  • Successful renal transplant (RTx) recipients have better life expectancy and quality of life, but they still face risk of higher morbidity and mortality with long-term immunosuppression and their underlying diseases, especially diabetes mellitus.

  • Liraglutide has a β-cell—protective effect from glucocorticoids and also prevents the toxicity of calcineurin inhibitors in vitro.

  • Liraglutide might be safely and effective to improve glycemic mangement in poor diabetic control RTx recipients.

Abstract

Background

Diabetes mellitus (DM) is the major cause of end-stage renal disease (ESRD) in Taiwan. Despite the use of steroids and/or calcineurin inhibitors (CNIs) in renal transplantation (RTx), additional challenges occur when a patient displays persisting metabolic disease, carries on an unhealthy lifestyle, or experiences genetic effects. Although RTx recipients could get better glycemic control by oral anti-diabetic drugs (OADs) or several insulin agents, they still need more than two kinds of medication. Liraglutide, a GLP-1 receptor agonist, stimulates insulin secretion and inhibits glucagon secretion and hepatic glucose production in a glucose-dependent manner. In addition, it delays gastric emptying and suppresses appetite through the central pathways. Herein we report on the long-term benefits of liraglutide in the management of DM in RTx recipients.

Methods

We retrospectively retrieved 7 RTx patients in August 2015, who had been prescribed liraglutide due to their poor glycemic control; however, 2 of them discontinued their scheduled doses within 1 month. The mean follow-up period was 19.4 ± 7.6 (range 10.5–27.6) months.

Results

Glycemic control improved fasting blood sugar (FBS) from an initial 228.6 ± 39.1 mg/dL to a final FBS of 166.0 ± 26.6 mg/dL (P = .103), with a significant improvement in nadir glucose control (136.4 ± 5.8 mg/dL, P = .017) and with glycated hemoglobin (HbA1c) from an initial 10.0 ± 1.6% to a final 8.1 ± 0.8% (P = .043). The average body weight was from an initial of 78.0 ± 7.8 kg to a nadir of 75.1 ± 9.1 kg (P = .032). Graft renal function of the estimated glomerular filtration rate (eGFR) significantly improved from an initial 67.7 ± 18.7 to a nadir of eGFR 76.5 ± 18.7 mg/dL (P = .024). There was no significant change in urinary protein:creatinine ratio.

Conclusion

Liraglutide may be safe and effective for RTx recipients with poor diabetic glycemic control, although there have been incidences of intolerance in some patients, and potential concern regarding absorption of oral medications due to a delay of gastric emptying. Evidence of liraglutide in diabetic RTx recipients is limited, so additional prospective clinical studies should be undertaken in the future.

Section snippets

Materials and Methods

We retrospectively retrieved 7 RTx patients in August 2015, who had been prescribed liraglutide with initial dose of 0.6 mg/day for 1 week adjusted every 0.6 mg weekly to optimal glycemic response upto maximal dose 1.8 mg/day due to poor glycemic control; however, 2 of them (28.6%) discontinued their scheduled doses within 1 month. One had nausea and vomiting, whereas the other had uncontrollable headaches, dizziness, and rhinorrhea. The initial renal function data were determined with serum

Benefits of Liraglutide in Diabetic RTx Recipients

The addition of liraglutide in diabetic RTx recipients improved sugar control through fasting blood sugar and HbA1c. It allowed for better graft renal function (Table 1). Although 4 patients (80%) had body weight (BW) reduction (range -2.1 to -3.0 kg) over a span of 10.5–27.6 months, 1 gained 8 kg during the management period of 17.3 months without a significant difference in BW control after liraglutide. The nadir BW (75.1 ± 9.1 kg) was a significant reduction from baseline BW (78.0 ± 7.8 kg; P

Discussion

ESRD patients nearly always recover their health and go on to experience a full life expectancy, along with a better quality of life after successful RTx. However, these patients continue to have higher morbidity and mortality rates (and their underlying diseases, particularly DM) than those in the general population, while also requiring long-term use of immunosuppressive agents. Chronic hyperglycemia has a detrimental cardiovascular effect as it triggers inflammatory responses and oxidative

References (13)

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This study was supported by a grant from Taichung Veterans General Hospital (TCVGH-1077302B and TCVGH-1077302B), Taichung, Taiwan.

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