Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis of Comparative Studies.

Background: Solid organ transplant recipients with diabetes mellitus face unique challenges in glycemic control, compounded by the metabolic effects of immunosuppressants. Although sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in diabetes, evidence for their use in transplant recipients remains limited. We aimed to systematically review the efficacy and safety of SGLT2 inhibitors in transplant recipients with diabetes. Methods: A systematic review and meta-analysis was conducted by searching the MEDLINE, Embase, and Cochrane CENTRAL databases for studies published before July 2025. Seventeen comparative studies involving 12,892 transplant recipients with diabetes were included. Efficacy and safety data of SGLT2 inhibitors were extracted and analyzed. A random-effects model was used to pool the results. Results: SGLT2 inhibitors led to a significantly greater reduction in HbA1c (mean difference [MD]: -0.59% and 95% confidence interval [CI]: -0.91 to -0.26) and body mass index (MD: -0.82 kg/m2 and 95% CI: -1.54 to -0.10) compared to controls. The risks of dialysis (odds ratio [OR]: 0.50 and 95% CI: 0.31-0.79), major adverse cardiovascular events (OR: 0.29 and 95% CI: 0.22-0.38), heart failure (OR: 0.66 and 95% CI: 0.52-0.83), urinary tract infection (OR: 0.45 and 95% CI: 0.22-0.92), graft rejection (OR: 0.73, 95% and CI: 0.64-0.83), and all-cause mortality (OR: 0.40 and 95% CI: 0.27-0.59) were significantly lower in the SGLT2 inhibitor group. Conclusions: SGLT2 inhibitors were associated with improved glycemic control, weight reduction, and favorable trends in cardiovascular outcomes among solid organ transplant recipients. Most safety outcomes, including urinary tract infection and graft rejection, were comparable between groups or more favorable in the SGLT2 inhibitor group, particularly among kidney transplant recipients. These findings support the use of SGLT2 inhibitors in this population. However, further large-scale studies are warranted to validate these results and assess the long-term effects across different transplant types.