Impact of Glucagon-Like Peptide-1 Agonist Use on Weight Trajectory and Clinical Outcomes Following Liver...

Glucagon-Like Peptide-1 (GLP-1) analogues are increasingly being used to manage diabetes and obesity. However, their use in liver transplant (LT) recipients remains understudied. This study aimed to evaluate the clinical outcomes associated with GLP-1 use following LT.

We conducted a retrospective cohort study of adult LT recipients between 2019-2023 at a single tertiary care center. Patients were divided into 2 groups based on GLP-1 use after transplant. Baseline demographics, comorbidities, transplant characteristics, and post-transplant outcomes were compared. Categorical variables were analyzed using Chi-square tests, and continuous variables using t-tests.

Among 368 LT recipients, 73 (19.8%) were prescribed GLP-1 analogues post-transplant and 295 (80.2%) were not. There was no difference in demographics. GLP-1 users had higher rates of diabetes (79.5% vs. 31.2%, p < .0001), hyperlipidemia (50.7% vs. 29.8%, p = .0012), and BMI at transplant (31.9 ± 6.3 vs. 28.5 ± 12.6, p = .0015). MASH was the leading indication for transplant in the GLP-1 group (61.9% vs. 38.1%, p < .0001). At year 1, GLP-1 users had lower rejection rates (12.3% vs. 23.1%, p = .0635), with a similar trend at 3 years (6.8% vs. 9.5%, p = .6322). At 3 years, mortality was lower in GLP-1 users (1.4% vs. 4.7%, p = .3293).

GLP-1 analogues were commonly used post-LT in patients with MASH and obesity. Despite higher metabolic burden at baseline, GLP-1 use was associated with similar or improved trends in BMI, rejection, and mortality. Larger prospective studies are needed to strengthen the evidence supporting the use of GLP-1 analogues in this high-risk population.