Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Transplant Recipients: A Systematic Review and Meta-analyses

Cahuapaza-Gutierrez N.L.; Calderon-Hernandez C.C.; Umeres-Bravo M.M.; Villavicencio-Escudero T.V. · American Journal of Cardiovascular Drugs (2026) · DOI: 10.1007/s40256-026-00792-x

Resumen

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood. Methods: Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1. Results: Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m2; 95% CI: − 2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: − 0.20%; 95% CI: − 0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29–1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25–7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: − 0.90 kg/m2; 95% CI: − 1.67 to − 0.14; p = 0.02) and systolic blood pressure (MD: − 4.69 mmHg; 95% CI: − 7.27 to − 2.12; p < 0.001). Conclusions: In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful. Systematic Review Registration: PROSPERO CRD420251057335. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026.

Instituciones: Universidad Científica del Sur