Introduction: Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors has well established favorable effects on glycemic control, cardiovascular outcomes, renal protection and reduction of all cause of mortality in diabetic patients. However, the side effects of SGLT2 inhibitors might limit it use in renal transplant population and data regarding this is emerging. In this paper we reviewed of the published studies and case series for the outcomes of SGLT2 inhibitors use and it is short term safety in diabetic renal transplant patients.
Method: We reviewed literature for published studies related to use of SGLT2 inhibitor in diabetic renal transplant recipients from March 2014 to March 2020, using (Pubmed and Google Scholar). Clinical characteristics, outcomes of SGLT2 inhibitor use and side effects were studied.
Results: a total of 6 published studies and one case report have been identified. Only one randomized placebo-controlled study on SGLT2inhibitor therapy (empagliflozin) in renal transplant recipients with post-transplant diabetes mellitus was conducted for 24 weeks (n=22 SGLT2i, n-22 placebo). Other studies were either prospective or retrospective. A total of 100 renal transplant recipients received SGLT2 inhibitors as add on medication for diabetic control. Mean age of patients ranged from 53 to 66 years and median duration of renal transplantation was between 2.7 to 9.6 years (5.45 years). Around 50% of renal transplant patients had diabetes mellitus (n= 49) and others had post-transplant new onset diabetes (NODAT) (n=51). Types of SGLT2 inhibitors used were canagliflozin (n=34), dapagliflozin (n=28), and empagliflozin (n=38). The duration of most of studies ranging from 6 months to 1 year which reflect the short term safety and efficacy of such drug. The mean baseline of HbA1c was 8 % with significant reduction to 7.1% at 6 months. There was no reported diabetic ketoacidosis and only one patient had hypoglycemia. Majority of patients started on SGLT2 inhibitors with stable renal function (eGFR more than 60 mL/min/1.73 m2). There was no episodes of rejections, no interaction with immunosuppressant medications and only one patient developed acute kidney injury stage 1.  Weight reduction was significant at 6 months ranged from 1kg to 2.5kg (mean weight at baseline 81.4kg).  There was no major effects on blood pressure. Infectious complications reported were: urinary tract infection (4), cystitis (2), genital yeast infection (1), and cellulitis (1).
Conclusion: SGLT2 inhibitors has favorable effects on weight reduction and glycemic control in diabetic renal transplant recipients (DM and NODAT).  The allograft function remained stable, no episodes of rejection or diabetic ketoacidosis were reported. SGLT2 inhibitor use is safe in short term, but large long term randomize control studies are required.