Kidney transplant recipients may benefit from using metformin
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Key takeaways:
- Metformin use correlates with reduced risk of death-censored graft failure in kidney transplant recipients.
- Future research is needed.
Kidney transplant recipients may benefit from using metformin due to its correlation with reduced death-censored graft failure, according to data published in the American Journal of Kidney Diseases.
“As kidney transplantation does not mean full recovery of renal function and these patients need a variety of medications, including immunosuppressants, after transplantation, special consideration is still needed when prescribing medications for kidney transplant recipients. However, few studies have been performed previously, and the evidence for metformin usage in kidney transplant recipients is less robust,” Soie Kwon, MD, MS, from the department of internal medicine at Seoul National University Hospital in Korea, and colleagues wrote. They added, “Considering the changing status of metformin, information on the long-term efficacy and safety of metformin usage in kidney transplant recipients is currently needed.”
In a retrospective cohort study, researchers investigated the clinical effects of metformin in 1,995 kidney transplant recipients with diabetes. A total of 1,193 patients used metformin (defined as using for more than 90 days), whereas 802 did not. Additionally, 1,565 patients were diagnosed with pre-transplantation diabetes mellitus (DM) and 430 were diagnosed with post-transplant diabetes mellitus (PTDM).
With metformin use serving as the exposure, researchers considered all-cause mortality and death-censored graft failure (DCGF) the primary outcomes of the study. Using multivariable Cox regression, researchers conducted survival analyses. They also performed competing risk analyses using Fine and Gray models. A time-varying covariate allowed researchers to model changes in metformin use over time.
Although metformin use correlated with a reduced risk for DCGF, researchers did not observe an association with all-cause mortality. In fact, a subgroup analysis revealed metformin use correlated with a reduction in all-cause mortality risk and DCGF among patients before and after transplantation.
Researchers identified a correlation between metformin and reduced risk of biopsy-proven acute rejection (BPAR) in the PTDM group. Overall, a higher dose of metformin was linked with lower risks of DCGF and BPAR.
“Our results suggest that the metformin dose can affect a patient’s outcome and therefore should be considered by physicians,” Kwon and colleagues wrote. They added, “In the future, further well-designed randomized controlled trials with PTDM defined according to American Diabetes Association criteria, and that account for SGLT2i use, are needed to validate our findings.”
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