Outcomes of GLP-1 Receptor Agonist Therapy after Liver Transplantation in Patients with Type 2 Diabetes: A Real-World Cohort Study

Guy Loic Nguefang; Sarpong Boateng; Solomon Gyabaah; Joel Gabin  Konlack; Yussif Issaka; Edgar Luna Landa; Tracy Chukwu; Elvis Eze; Basile Njei

doi:10.15403/jgld-6863

Authors

Guy Loic Nguefang Texas Tech University Health Sciences Center, Odessa, TX, United States
Sarpong Boateng Yale New Haven Health, Bridgeport Hospital, New Haven CT, United States
Solomon Gyabaah Komfo Anokye Teaching Hospital, Kumasi, Ghana
Joel Gabin Konlack New York City Health and Hospitals South Brooklyn Health, Brooklyn, NY, United States
Yussif Issaka Yale New Haven Health, Bridgeport Hospital, New Haven CT, United States
Edgar Luna Landa Texas Tech University Health Sciences Center, Odessa, TX, United States
Tracy Chukwu Texas Tech University Health Sciences Center, Odessa, TX, United States
Elvis Eze Yale University, New Haven, CT, United States
Basile Njei Yale University, New Haven, CT, United States; Engelhardt School of Global Health and Bioethics, Euclid University, Central African Republic

DOI:

https://doi.org/10.15403/jgld-6863

Keywords:

Liver Transplantation, Type 2 Diabetes Mellitus, GLP-1 Receptor Agonists, Post-Transplant Outcomes, Mortality

Abstract

Background and Aims: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used to manage type 2 diabetes mellitus (T2DM) in liver transplant (LT) recipients, but their impact on graft outcomes remains unclear. This study evaluated clinical and graft-related outcomes associated with GLP-1 RA therapy.

Methods: We conducted a retrospective cohort study using the TriNetX Network, identifying adults with LT and T2DM. Two cohorts were defined: LT recipients treated with GLP-1 RAs and those receiving conventional antidiabetic therapy. Propensity score matching (1:1) was applied based on demographics, comorbidities, and immunosuppressive regimens. The index date was the first GLP-1 RA prescription within six months before or after LT. Outcomes assessed at one year included all-cause mortality, graft rejection, graft failure, biliary stricture, hepatic artery thrombosis, and transplant-related infections. Analyses used Kaplan–Meier survival curves and Cox proportional hazards models.

Results: After matching, 704 patients were included in each cohort. GLP-1 RA use was associated with significantly lower mortality (4.2% vs. 12.6%; HR=0.33, 95%CI: 0.22–0.50; p<0.0001) and reduced risks of rejection (9.0% vs. 15.5%; HR=0.55; p=0.0008), graft failure (7.1% vs. 13.8%; HR=0.50; p=0.0002), biliary stricture (4.1% vs. 6.7%; HR=0.60; p=0.0342), infections (5.7% vs. 10.1%; HR=0.54; p=0.0032), and hepatic artery thrombosis (5.4% vs. 10.7%; HR=0.48; p=0.0007).

Conclusions: GLP-1 RA therapy was associated with improved survival and lower rates of major post-transplant complications, suggesting a potential role as preferred antidiabetic therapy in LT recipients with T2DM.