GLP-1RAs confer ‘metabolic benefit,’ lower odds for MASLD after liver transplantation

Key takeaways:

• Patients with diabetes prescribed GLP-1RAs were less likely to develop MASLD following liver transplantation.
• GLP-1RAs were well tolerated, with no significant changes in renal function.

SAN DIEGO — Patients with diabetes who were prescribed glucagon-like peptide-1 receptor agonists had lower odds of metabolic dysfunction-associated steatotic liver disease after liver transplantation, noted a presenter at The Liver Meeting.

“GLP-1RAs are quickly becoming the cornerstone of diabetes and weight loss management,” Mohammad S. Siddiqui, MD, from the Virginia Commonwealth University, told Healio. “Liver transplant recipients are at increased metabolic risk and will likely benefit from GLP-1RA; however, there is currently no safety and efficacy data in the liver transplant population, which limits its use in these patients.”

He added: “The main aim of our study was to provide safety and tolerability data for the transplant community, and to demonstrate the metabolic benefit of GLP-1RA in liver transplant patients.”

In their retrospective study, Siddiqui and colleagues enrolled 76 patients with type 2 diabetes who had undergone LT at Virginia Commonwealth University and had received either GLP-1RAs or insulin therapy following transplantation. The researchers propensity matched 1:1 patients receiving GLP-1RAs (n=38) with those receiving insulin therapy (n=38) according to age, gender, ethnicity, metabolic dysfunction-associated steatohepatitis, and immunosuppression.

According to results presented at the Liver Meeting, after 12 months of therapy, patients who had received GLP-1RAs vs. insulin therapy were more likely to lose weight after transplantation (P < .001), demonstrated lower hepatic far content, defined by controlled attenuation parameters (P = .017) and had lower odds of developing metabolic dysfunction-associated steatotic liver disease (P = .02).

“There were no safety concerns, such as renal function, adjustment of immunosuppression, rejection or infection,” Siddiqui told Healio, and, aside from “mild nausea in the beginning,” GLP-1RAs were well tolerated.

Siddiqui also noted that, after hemoglobin levels were measured, patients on GLP-1RAs demonstrated “better glycemic control,” but the drugs did not alter the serum lipid profile.

“GLP-1RAs have beneficial effects in liver transplant recipients,” Siddiqui told Healio. “This the first data that demonstrate the use of GLP-1RAs – albeit in a retrospective fashion – in liver transplant recipients using a standardized control group. This should reassure providers who want to use them in clinical practice as they are not only beneficial for treatment of diabetes and weight but also other factors, such as MASLD.”

In an effort to gather more data on the safety and efficacy of GLP-1RAs following LT, Siddiqui and colleagues are currently conducting a double-blind randomized controlled trial of semaglutide in LT recipients.

“The study design is such that we are treating patients early after liver transplant,” Siddiqui told Healio. “This has major implications as we are not reacting after patients have developed evidence of end-organ damage or are at significant risk for it, but rather we are treating early as a preventive approach.”