Related Experiment Video

Updated: May 20, 2025

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
09:12

A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation

Published on: April 27, 2019

9.5K

Effect of sodium glucose cotransporter 2 inhibition immediately prior to heart transplantation

Lisa M Raven1,2,3, Christopher A Muir1,3, Ricardo C Deveza3,4,5

  • 1Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.

JHLT Open
|March 27, 2025
PubMed

Insights

Sodium glucose cotransporter 2 inhibitors (SGLT2i) are safe for patients undergoing heart transplantation. SGLT2i use did not increase acidosis risk and was associated with shorter ICU stays and improved survival.

Area of Science:

  • Cardiology
  • Endocrinology
  • Transplantation Medicine

Background:

  • Sodium glucose cotransporter 2 inhibitors (SGLT2i) are vital for managing type 2 diabetes and heart failure.
  • Current guidelines recommend discontinuing SGLT2i before surgery due to ketoacidosis concerns.
  • Orthotopic heart transplantation (OHT) often occurs emergently, precluding preoperative SGLT2i cessation.

Purpose of the Study:

  • To evaluate the safety of continuing SGLT2i therapy up to the time of OHT.
  • To assess the incidence of postoperative acidosis and ketoacidosis in OHT recipients on SGLT2i.
  • To compare outcomes, including ICU length of stay and survival, between SGLT2i-exposed and unexposed OHT patients.

Main Methods:

  • Retrospective analysis of 163 OHT recipients.
  • Comparison of 40 patients exposed to SGLT2i with 123 patients not exposed.
  • Assessment of postoperative acidosis severity and ketoacidosis occurrence.

Main Results:

  • No significant increase in mild, moderate, or severe acidosis was observed in the SGLT2i-exposed group.
  • Zero cases of ketoacidosis occurred, attributed to routine postoperative insulin infusions for hyperglycemia (97% of patients).
  • SGLT2i-exposed patients experienced shorter intensive care unit (ICU) stays and improved overall adjusted survival.

Conclusions:

  • Continuing SGLT2i therapy until the time of OHT is safe.
  • Routine postoperative insulin infusion effectively mitigates the risk of ketoacidosis in this population.
  • SGLT2i use in OHT recipients may be associated with improved clinical outcomes.
Keywords:
SGLT2heart transplantketoacidosispreoperativesodium glucose cotransporter 2

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