Safety and Tolerability of SGLT-2 Inhibitors Following Lung Transplantation

Sodium-glucose cotransporter-2 inhibitors (SGLT2i's) are frequently prescribed for T2DM control, with additional efficacy in congestive heart failure therapy and preserving renal function in CKD. Despite their potential to mitigate comorbidities, prescribing of SGLT2i's following solid organ transplantation has been limited due to safety concerns regarding infection, renal function, and diabetic ketoacidosis. SGLT2i prescription following transplantation of other solid organs has been evaluated, but only one study included a limited number of lung transplant recipients. We performed a retrospective case control study of all patients in Michigan Medicine clinics with a prior lung transplant who were prescribed an SGLT2i between January, 2010 and March, 2023. We collected demographic information, medical history pertaining to transplant, SGLT2i prescription history, and abstracted safety, tolerability, and efficacy outcomes for comparison between the SGLT2i cohort and a control population. Among 20 patients who met inclusion criteria, median SGLT2i prescription duration was 372 days. There were no UTI's or GU infections, and severe AKI occurred in five patients. There was a median reduction of 0.6% in hemoglobin A1c within the SGLT2i group not observed in controls (p = 0.09). Our findings demonstrate safety and tolerability of SGLT2i's following lung transplantation and suggest efficacy in controlling T2DM or PTDM.