グルカゴン様ペプチド1受容体作動薬療法と心移植後の転帰との関連

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have demonstrated survival benefits and cardioprotective effects in diabetic and heart failure (HF) patients. However, the association of GLP-1RAs use with mortality and morbidity in heart transplant (HT) recipients has not been previously investigated.

All adult patients who underwent HT at three Mayo Clinic sites and survived at least one month after the procedure were assessed. GLP-1RAs use was extracted retrospectively from the electronic medical records (EMR) after the HT. All-cause mortality and hospitalization due to graft dysfunction, graft rejection, vasculopathy, de novo DM, and dialysis were collected and compared between patients exposed and non-exposed to GLP-1RA using Kaplan-Meier curves, cumulative incidence functions, and multivariate Cox regression analyses incorporating GLP-1RA exposure as a time varying covariate.

A total of 1914 patients were included with a median age of 56.3 (46.1, 62.8) years and 71.2 % were male. The median follow up was 5.5 (2.2,10.2) years and 285 (14.9 %) used GLP-1RAs following HT. In the multivariable time-dependent Cox analysis, GLP-1RA therapy was associated with lower risk of all-cause mortality (HR: 0.33, 95 % CI: 0.12 to 0.90; p = 0.031), but not with hospitalization due to graft dysfunction (HR: 0.95, 95 % CI: 0.45 to 2.01; p = 0.900) or other outcomes through 5-year follow-up.

Therapy with GLP-1RAs was associated with a lower risk of all-cause mortality in HT recipients. While the mechanisms of these associations need further investigations, these findings, suggest a potential therapeutic role to improve survival after HT.