Early safety observations of peri-transplant SGLT2 inhibitor use in lung transplant recipients.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) provide cardiovascular and renal benefits in non-transplant populations, but their safety in lung transplant recipients remains poorly defined, particularly during the peri-transplant period. We evaluated early postoperative complications, long-term allograft outcomes, and adverse events associated with SGLT2i exposure before transplantation or within the first 90 days after lung transplantation (LTx). Methods: We performed a single-center retrospective cohort study of 443 adult recipients who underwent primary isolated LTx at Northwestern University between January 2018 and May 2024. Patients were classified according to peri-transplant SGLT2i exposure, defined as either ongoing use at the time of transplantation or de novo initiation within 90 days after transplantation. Early outcomes included primary graft dysfunction (PGD) grade 3 at 72 hours and major postoperative complications. Long-term outcomes included chronic lung allograft dysfunction (CLAD) and overall survival. Time-to-event analyses for CLAD and survival used a postoperative day-90 landmark. Multivariable logistic and Cox regression analyses were performed. Results: Among 443 recipients, 11 (2.5%) were exposed to SGLT2i either before transplantation or within 90 days after transplantation; 7 were receiving SGLT2i at the time of transplant and 4 initiated therapy Conclusions: In this single-center cohort, peri-transplant SGLT2i exposure was uncommon but was not associated with worse early graft outcomes, CLAD, or survival among treated patients. These findings suggest a reassuring early safety and feasibility signal for carefully selected lung transplant recipients and support the need for larger multicenter studies.