BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
