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Dapagliflozin Use in Children with Advanced Heart Failure Undergoing Heart Transplantation: A Matched Case-Control
David M Newland1,2, Yuk M Law3,4, Erin L Albers3,4
1Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA. David.Newland@seattlechildrens.org.
Insights
Preoperative dapagliflozin use in children undergoing heart transplantation (HTx) did not lead to adverse events in the immediate postoperative period. This study suggests potential cardiovascular benefits of dapagliflozin in pediatric HTx candidates should be considered.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, is known to cause euglycemic ketoacidosis in diabetic adults.
- The safety of preoperative dapagliflozin in non-diabetic pediatric heart transplantation (HTx) recipients is not well-established.
Purpose of the Study:
- To evaluate the safety and adverse events (AE) associated with preoperative dapagliflozin use in non-diabetic children undergoing HTx.
- To compare postoperative outcomes between pediatric HTx recipients who received dapagliflozin and those who did not.
Main Methods:
- A single-center, matched case-control study.
- Nondiabetic pediatric primary HTx recipients (<21 years) were analyzed.
- Cases (n=22) receiving dapagliflozin were matched to controls (n=44) not receiving the drug, followed through postoperative day 3.
Main Results:
- No significant differences were observed in blood glucose levels, acid-base balance, or lactate levels between groups.
- Vasopressor, inotrope, and insulin infusion requirements were similar.
- No cases of severe hypoglycemia, euglycemic ketoacidosis, or urinary tract infections were reported. No deaths occurred.
Conclusions:
- Preoperative dapagliflozin use in pediatric patients with advanced heart failure awaiting HTx is not associated with immediate postoperative adverse events.
- Hospitalization length and ICU stay were comparable between groups.
- Potential cardiovascular benefits of dapagliflozin in this population warrant further consideration.
Abstract:
Dapagliflozin has been associated with euglycemic ketoacidosis in adults with diabetes contributing to poor outcomes when continued prior to surgery. It is unknown if preoperative use of dapagliflozin may lead to adverse events (AE) in nondiabetic children with advanced heart failure (HF) undergoing heart transplantation (HTx). We performed a single-center, matched case-control analysis of nondiabetic primary pediatric HTx recipients < 21 years-old who underwent HTx and followed through postoperative day (POD) 3. Cases who received dapagliflozin leading up to HTx (n = 22) were matched by age and cardiac diagnosis to two historical controls who did not receive dapagliflozin (n = 44). Median age at HTx was 13.8 years (range 0.36-20.7) and 48% were female. Cardiac diagnoses included cardiomyopathy (45%), Fontan failure (41%), and single ventricle status post stage I palliation (14%). Cases received median dapagliflozin dose of 0.17 mg/kg once daily; therapy was stopped one day prior to HTx. There were no significant differences in blood glucose nadirs, arterial blood gas indices including nadirs of pH, bicarbonate, or peaks of arterial blood lactic acid POD0-3. Vasopressor, inotrope, and insulin infusion usage were not different. No patients were treated for severe hypoglycemia, euglycemic ketoacidosis, or urinary tract infections. There were no deaths. Length of stay in ICU and time from HTx to hospital discharge did not differ between cohorts. Use of dapagliflozin in children with advanced HF until HTx is not associated with AE in the immediate postoperative period nor increased length of hospitalization post-HTx. Potential cardiovascular benefits of dapagliflozin in patients awaiting HTx should be prioritized.
