Tolerability and Effectiveness of Glucagon-Like Peptide-1 Receptor Agonists in Lung Transplant Recipients: A Single Center Report

No SJR dataDec 8, 2024Transplantation proceedings

How Well Glucagon-Like Peptide-1 Drugs Work and Are Tolerated in Lung Transplant Patients

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Abstract

Thirty-seven percent of lung transplant recipients stopped glucagon-like peptide-1 receptor agonists due to side effects.

The median total time of GLP-1RA use among participants was 590 days.
Nausea and vomiting were the most common side effects leading to discontinuation.
The median percent change in weight at 12 months post-initiation was -2.5%.
Discontinuation rates and weight loss in lung transplant recipients were higher and lower, respectively, compared to the general population.
Most lung transplant recipients were able to tolerate long-term use of GLP-1RA.

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INTRODUCTION: Diabetes and obesity increase risk of death after lung transplantation. Optimal treatment of diabetes and obesity may improve post-transplant outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are FDA-approved to treat diabetes and obesity and demonstrate improvement in renal and cardiovascular outcomes in the general population. However, side effects may limit tolerability in lung transplant recipients. We hypothesized that GLP-1RA would be stopped due to side effects in a higher proportion of lung transplant recipients compared to the general population but result in weight loss for those who were able to tolerate them.

METHODS: We performed a single-center case series of lung transplant recipients initiated on a GLP-1RA post-transplant between April 1, 2005 and December 31, 2023. We assessed side effects and complications during GLP-1RA use. Weight was assessed at time of GLP-1RA initiation and 3-, 6-, and 12-months postinitiation.

RESULTS: Fifty-nine lung transplant recipients initiated a GLP-1RA during the study period with a median (IQR) total time of use of 590 (280-891) days. Thirty-seven percent (22/59) stopped the medication due to side effects, with nausea and vomiting being most common. The median (IQR) percent change in weight at 12-months post-GLP-1RA initiation was -2.5% (-8.7% to 1.5%).

DISCUSSION: We report the largest study evaluating GLP-1RA use in lung transplant recipients. Discontinuation rates are higher and weight loss is lower than in the general population. However, most lung transplant recipients tolerated long-term use of GLP-1RA. Further work is required to identify which recipients are most likely to benefit and how to optimize tolerability.

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