Abstract / Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for multiple populations-type 2 diabetes (T2D), chronic kidney disease, and heart failure-but their role after heart transplant (HTX) remains unclear. We searched PubMed, Cochrane, and Embase for studies of HTX recipients with T2D comparing outcomes in SGLT2i users vs. non-users. Outcomes of interest were all-cause mortality, urinary tract infection (UTI), and estimated glomerular filtration rate (eGFR) change from baseline. Odds ratios (ORs) and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were pooled using a random-effects model for binary outcomes. Three retrospective observational studies were included in the all-cause mortality meta-analysis, four in the UTI incidence meta-analysis, and five in the qualitative analysis evaluating eGFR change (n = 3,564). Mean follow-up ranged from 9 to 83 months. SGLT2i use was associated with a lower risk of all-cause mortality compared with non-use in both unadjusted (OR 0.43; 95% CI 0.26-0.71; p < 0.001; I² = 79%) and adjusted analyses (aHR 0.69; 95% CI 0.51-0.93; p = 0.02; I² = 20%), without increasing the risk of UTI (OR 0.77; 95% CI 0.14-4.05; p = 0.75; I² = 48%). Most studies suggested stable or increased eGFR from baseline with SGLT2i exposure. SGLT2i use, compared with non-use, was associated with lower all-cause mortality without an increased incidence of UTIs in HTX recipients with T2D. Additionally, the pooled data suggest a possible renal benefit. The totality of these observational data, despite their limitations, provide important context for ongoing SGLT2i use following HTX.
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