Introduction: Weight gain and metabolic dysfunction are increasingly recognized as major challenges after liver transplantation. Obesity, diabetes, dyslipidemia, and metabolic dysfunction–associated steatotic liver disease can adversely affect graft health, increase cardiovascular risk, and compromise long-term survival.
Introduction:
Weight gain and metabolic dysfunction are increasingly recognized as major challenges after liver transplantation. Obesity, diabetes, dyslipidemia, and metabolic dysfunction–associated steatotic liver disease can adversely affect graft health, increase cardiovascular risk, and compromise long-term survival. As glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated substantial metabolic benefits in the general population, there is growing interest in their use among liver transplant recipients. However, concerns regarding safety, drug interactions, graft function, and immunosuppression have limited widespread adoption.
Problem Statement:
Evidence supporting the use of GLP-1RAs after liver transplantation remains limited, with uncertainty regarding their impact on graft outcomes, rejection risk, immunosuppressant levels, and cardiovascular safety. Robust real-world data are needed to determine whether these agents can effectively manage post-transplant weight gain without compromising allograft function.
Summary:
This multicenter international study evaluated the safety and effectiveness of GLP-1RAs in adult liver transplant recipients and provides reassuring evidence supporting their use in post-transplant metabolic management. Treatment with GLP-1RAs resulted in meaningful reductions in body weight, body mass index, and glycemic parameters, with additional modest improvements in lipid profiles. Importantly, these benefits were achieved without evidence of adverse effects on liver graft function, kidney function, or immunosuppressive drug levels. Matched analyses further confirmed superior weight loss and glycemic control among GLP-1RA users compared with non-users. Notably, there was no increased risk of allograft dysfunction, acute cellular rejection, or major adverse cardiovascular events. Semaglutide was the most commonly prescribed agent, reflecting current clinical practice patterns. These findings are particularly relevant as metabolic complications have emerged as a major determinant of long-term outcomes after transplantation. The study suggests that GLP-1RAs may offer a valuable therapeutic strategy for addressing post-transplant obesity and diabetes while maintaining graft safety. Although the observed weight loss was moderate and treatment doses were relatively low, the overall safety profile was highly encouraging. Prospective randomized trials are now needed to define optimal dosing strategies, long-term efficacy, and their potential role in preventing post-transplant metabolic and cardiovascular complications.
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