Empagliflozin Use in the Management of Diabetes Following Cardiac Transplantation

Presentation Number: LB SUN 76
Date of Presentation: April 2nd, 2017

Christopher Alan Muir1, Jerry R Greenfield*2 and Peter Macdonald1
1St. Vincent's Hospital, Sydney, Darlinghurst, Australia, 2Garvan Inst of Medical RES, Sydney, Australia

Abstract

Background: Diabetes occurs commonly following cardiac transplantation and has been associated with adverse cardiovascular and transplant-related outcomes compared to non-diabetic heart transplant recipients. Empagliflozin, a novel agent for the treatment of diabetes, improves cardiovascular and renal outcomes in the non-transplant setting, but the safety and efficacy of empagliflozin use in transplant recipients is unknown. Methodology: We performed a review of empagliflozin use in heart transplant recipients attending St. Vincent’s Hospital, Sydney between 01/01/2016 and 31/08/2016. Results: Among 316 heart transplant recipients, the prevalence of diabetes was 33%. Attendees were predominately male (71%) with a mean age of 55.8 (±14.4) years. Average diabetes duration was 7.9 (±7.4) years and average time from cardiac transplantation was 9.6 (±8.3) years. Nineteen diabetic patients were treated with empagliflozin in addition to standard therapy. All but two patients commenced empagliflozin following cardiac transplantation. Median time to commencement of empagliflozin after transplant was 5.5 years (IQR 0-11). Median treatment duration was 9 months (IQR 6.5-11). At baseline, hypertension was present in 18 (95%) of patients on empagliflozin, with chronic kidney disease present in 17 (89%). Pre-post data with greater than 3 months of follow-up was available for 16 heart transplant recipients. Empagliflozin use resulted in a significant mean (±SD) reduction in body weight of 2.7 kg (±5.1; p = 0.05), with a reduction in BMI of 0.9 kg/m2 (±1.7; p = 0.04). Weight reduction occurred despite a decrease in mean frusemide dose (p = 0.05). Following empagliflozin use, systolic blood pressure was reduced by 12 mmHg (±19; p = 0.03) and diastolic blood pressure was reduced by 7 mmHg (±11; p = 0.03). There was a non-significant improvement in HbA1c of 0.6% (Table 1). Empagliflozin was well tolerated. After 147 months of cumulative empagliflozin exposure in 19 patients, only 2 experienced side effects. One patient reported dizziness, while the other reported polyuria and exacerbation of pre-existing lower urinary tract symptoms. No serious adverse events or genitourinary infections were documented over the study period. Discussion: Our study supports the use of empagliflozin in patients with diabetes following cardiac transplantation. No genitourinary infections were documented despite active immunosuppression. It remains to be determined whether empagliflozin improves cardiovascular outcomes in transplant recipients, but our data suggest that treatment is associated with metabolic benefits including reduction in weight and blood pressure without adversely effecting renal function.

 

Nothing to Disclose: CAM, JRG, PM