Glucagon-like peptide-1 receptor agonist use and clinical outcomes after lung transplantation: A single-center cohort study

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly used for diabetes and obesity, but their safety and clinical impact after lung transplantation (LTx) are unclear.

We performed a single-center retrospective cohort study of adults undergoing primary LTx from 2018 to 2024. GLP-1 RA exposure was defined as either active treatment at the time of transplantation and/or GLP-1 RA use within the first 90 postoperative days. We compared early postoperative complications (including primary graft dysfunction grade 3 (PGD3), acute kidney injury, and respiratory infection), chronic lung allograft dysfunction (CLAD)-free survival, and overall survival according to GLP-1 RA use, using multivariable logistic regression and Cox models adjusted for key clinical covariates.

Forty-two recipients received GLP-1 RA for obesity or diabetes and typically initiated months before LTx. Potential GLP-1 RA-related complications after lung transplant occurred in 4 patients (9.5%); therapy was discontinued in 3 patients (7.1%). Compared with non-users, GLP-1 RA recipients had higher body mass index and more diabetes, but pre-LTx GLP-1 RA use was not independently associated with PGD3 or other early complications. GLP-1 RA use within 90 days after LTx was not associated with postoperative aspiration or respiratory infection. In time-to-event analyses, GLP-1 RA use within 90 days was not associated with CLAD-free survival or overall survival.

In this small, retrospective cohort with limited GLP-1 RA exposure, GLP-1 RA use before and early after transplantation was not associated with worse early or late outcomes, including CLAD and mortality, and was generally well tolerated. These results are reassuring but should be interpreted cautiously; prospective studies in larger cohorts are needed to confirm safety and to define optimal patient selection and timing.