Background: The most common cause of end-stage renal disease (ESRD) is diabetes mellitus (DM). Kidney transplantation offers better outcomes for ESRD patients. Patients could develop post-transplant DM (PTDM). Management of DM after transplantation (whether the patient had it from before or after the transplant) is challenging. Different medications could be used to manage PTDM. Those medications have good safety and efficacy record in general population and patients with mild degrees of kidney disease. At the same time, weight gain is a major issue after kidney transplant.

Methods: We conducted a retrospective single center analysis of safety and efficacy of Semaglutide after kidney transplantation. The study was approved by institutional review board. We collected data (demographics, laboratory tests and any symptoms or hospitalizations) for 28 patients for 12 months.

Results: All 28 patients took subcutaneous Semaglutide at an average of 0.5 mg/week throughout the study period. Patients’ average age was 64. Thirteen were females and all from Middle Eastern decent and had kidney transplant on average of 29 months when they were included in the study. Eleven patients had DM before the transplant and the rest had PTDM. 15 patients were on metformin and 10 were on insulin while the rest were not on any other medications at the start of the study. Baseline average creatinine was 1.2 mg/dL (106.3 mmol/L) and glycated hemoglobin (HbA1c) of 8.4 g/dL at the start of the study while creatinine was 1.1 mg/dL (97.5 mmol/L) and HbA1c was 7.1 g/dL at the end. HbA1c dropped 1.2 on average within 6 weeks of starting Semaglutide and stayed around the same level for the rest of the study. Urine protein decreased significantly within 6 months and was maintained throughout the study. One patient developed unstable angina during the study and another one was hospitalized with acute pancreatitis. A third patient developed bacterial pneumonia. Ten patients had nausea and vomiting after starting Semaglutide but that resolved 2 weeks later with lowering the dose. No allergic reactions or hypoglycemia episodes were reported. The average weight dropped 3.1 kg throughout the study and body mass index changed from 28.9 to 27.3. Only one patient stopped the medication during the study (the one who had acute pancreatitis).

Conclusion: In this retrospective analysis, Semaglutide seems to be safe and efficacious after kidney transplantation. It can be considered to manage DM after transplantation.