THU275 Tacrolimus Levels And Kidney Function In Kidney Transplanted (KT) Patients With Diabetes On Glucagon Like-1 Receptor Agonists (GLP1-RA)
Authors: Campana Mario S , Kumar Vineeta , Redden David , Zelada Castro Henry Jorge 
Published: October 2023

Abstract
Disclosure: M.S. Campana: None. V. Kumar: None. D. Redden: None. H.J. Zelada Castro: None.
Introduction: Uncontrolled Diabetes after solid-organ transplantation is associated with an increased risk of cardiovascular disease and renal graft loss. GLP1-RA are commonly used in the management of diabetes in non-transplanted populations because of cardio-metabolic benefits; however, their impact on tacrolimus absorption and kidney function in the post-transplant period has not been adequately studied. We aim to describe the association of blood tacrolimus levels, dose adjustments and kidney function in KT participants with diabetes who received GLP1-RA to participants who did not. Methods: We analyzed 50 adults with diabetes who underwent KT from 08/2020 to 08/2022 at UAB-Transplant Institute. 25 participants on insulin ± oral antidiabetic medications initiated GLP1RA (cases) and 25 participants on insulin ± oral antidiabetic did not start GLP1RA (controls). GLP1RA was started 7.72 months±5.26 after KT and 88% of them were on GLP1RA for the first time. Case group did not report active gastrointestinal symptoms and were educated to eat small-meal portions. We assessed number of times tacrolimus were at target [4-7 ng/ml], above or below target, number of times tacrolimus doses were adjusted, GFR and rejection rates (kidney biopsy) before GLP1RA therapy, 3 and 6 months after. For the comparison of categorical variables between groups, we used Pearson’s Chi-Square Test. Due to observed deviations from normality; we compared the distributions of counts and continuous outcomes between groups using Wilcoxon Rank Sum Tests. All tests were conducted using SAS 9.4. Results: KT participants (case, control) were predominantly of age (56.28 years, 57.40 years (p=0.66)), male (64%, 64% (p=1.0)), African American (60%, 84% (p=0.23)) and with a transplant rejection rate of 16% vs. 20% (p=0.71). There was a statistical difference in creatinine, GFR, and tacrolimus dose adjustments between the two groups. 1) Creatinine: Cases (at 6 months,1.48 mg/dL ± 0.41), Controls (at 6 months, 2.74 ± 2.38) (p=0.03). 2) GFR: Cases (at 6 months, 53.44 ml/min ± 15.89 ), Controls (at 6 months, 40.34 ± 17.75) (p=0. 038). 3) Number of Times Tacrolimus levels were out of range: Cases (at 3 months, 1.44 ± 1.08), Controls (at 3 months, 2.08 ± 0.81) (p= 0.02). 4) Number of times tacrolimus dose was increased: Cases (at 6 months, 0.12 ± 0.33), Controls (at 6 months, 0.36 ± 0.49) (p=0.04). None of the participants developed significant gastrointestinal side effects and the rate of GLP1RA discontinuation was 0%. Conclusion: Participants who took GLP1RA had better-preserved kidney function compared to those who did not, especially in the early post-kidney transplant period. Contrary to concern for altered tacrolimus absorption, patients treated with GLP1RA did not appear to have altered absorption requiring dose adjustment and can be used safely with minimal side effects and better efficacy compared to standard-of-care treatment.
Presentation: Thursday, June 15, 2023