Korean J Transplant.  2022 Nov;36(Supple 1):S357. 10.4285/ATW2022.F-4987.

Effectiveness of metformin in kidney transplant recipients with posttransplantation diabetes mellitus

• Lee D
• Jung J
• Lee J
• Shin SJ
• Kim S
• Baek CH
• Park SK
• Park JY
• Kim H

• KMID: 2535584
• DOI: http://doi.org/10.4285/ATW2022.F-4987

Abstract

Background
Posttransplantation diabetes mellitus (PTDM) is an important risk factor for cardiovascular disease and mortality. We aimed to determine the effects of metformin on cardiovascular and graft outcome in PTDM.
Methods
We collected 1,663 kidney transplant (KT) recipients without preexisting diabetes mellitus. PTDM was defined as hypoglycemic treatment was initiated after transplantation and maintained over 90 days. We conducted propensity score matching between metformin and non-metformin group, and estimated the effects of the metformin usage on percutaneous coronary intervention (PCI), major adverse cardiovascular events, acute rejection, and graft failure.
Results
PTDM incidence was 38.1% (n=634), and 406 recipients (65.7%) were treated with metformin. The metformin usage was associated with lower risk of PCI in Kaplan-Meier (log-rank test, P=0.026) and Cox regression analyses (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.08–0.73; P=0.013). Stronger protective effects of long-term use of metformin (1,192 days, median value) were found on PCI (HR, 0.22; 95% CI, 0.05–0.98; P=0.046) and graft failure (HR, 0.45; 95% CI, 0.21–0.94; P=0.033). In the subgroup administered tacrolimus, metformin lowered the risk of PCI (HR, 0.24; 95% CI, 0.07–0.87; P=0.03), graft failure (HR, 0.35; 95% CI, 0.17–0.72; P=0.004), and significant annual decrease difference in estimated glomerular filtration rate between met-formin group (–0.053 mL/min/1.73 m ² ) and non-metformin group (–1.31 mL/min/1.73 m ² ) was observed (P<0.001).
Conclusions
This study demonstrates that metformin use is associated with a decreased risk of coronary artery disease in KT recipients with PTDM. Renoprotective effect of metformin was observed in those who were administered tacrolimus.