Oral semaglutide in kidney transplant recipients with metabolic syndrome: three Japanese cases

Abstract

Abstract Background Renal transplant recipients with chronic kidney disease often develop post-transplant diabetes mellitus or metabolic syndrome (MetS), which are poor prognostic factors after renal grafts. Although recent studies have reported the protective effects of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the heart and kidneys, few have assessed its effects in renal transplant patients. Moreover, to our knowledge there have been no studies on the effects of oral GLP-1RA (semaglutide) in renal transplantation recipients in Japan. Case presentation Case 1 was a 52-year-old male renal transplant recipient with MetS. Semaglutide was administered orally for 12 months, starting at 3 mg/day and titrating up to 14 mg/day. Over time, his HbA1c level decreased from 5.9 to 5.5% and weight from 100.6 to 96.3 kg. No adverse events were observed. Case 2 was a 62-year-old male renal transplant recipient with MetS. Oral semaglutide was started at 3 mg/day. However, the patient had severe nausea, and the dose was reduced to 1.5 mg/day and then gradually increased to 14 mg/day for 12 months. Over time, triglyceride decreased from 308 to 277 mg/dL and weight decreased from 75.4 to 63.2 kg. Case 3 was a 59-year-old male renal transplant recipient with MetS and fatty liver. Oral semaglutide was started at 3 mg/day and titrated up to 12 mg/day for 12 months. Over time, triglyceride decreased from 205 to 119 mg/dL and weight decreased from 79.1 to 76.4 kg. No adverse events were observed. Conclusions In all three patients, oral semaglutide significantly reduced body weight and improved metabolic parameters. Additional studies are needed to further evaluate the efficacy of oral semaglutide and the incidence of associated adverse events in a large number of renal transplant recipients. Trial registration: UMIN, UMIN000050853. Registered 14 April 2023—Retrospectively registered, https://center6.umin.ac.jp/cgi-bin/ctr/ctr_reg_rec.cgi