Sajad Khiali
1,2 
, Mohammadreza Ardalan
3, Ali Sharifi
4, Amin Sadrazar
5, Afra Rezagholizadeh
6 , Parvin Sarbakhsh
7, Zeinab Javadivala
8, Sama Samankan
6, Amin Aghabalzadeh
6, Mohammad Reza Afshar Mogaddam
2, Afshin Gharekhani
2* , Mahboob Nemati
2,9* 1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Food and Drug Safety Research Center, Pharmaceutical Sciences Institute, Tabriz University of Medical Sciences, Tabriz, Iran
3 Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of General Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
5 Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
6 Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
7 Department of Statistics and Epidemiology, Faculty of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
8 Department of Health Education & Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
9 Pharmaceutical Analysis Research Center, Pharmaceutical Sciences Institute, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Despite the growing body of evidence supporting the beneficial effects of sodium-glucose transporter 2 (SGLT-2) inhibitors on metabolic, cardiovascular, renal, and mortality outcomes in the wide range of diseases, clinical data in patients with solid organ transplantation (SOT) is limited. A systematic literature search was conducted in PubMed, Scopus, and Web of Science from database inception until April 14, 2025, to evaluate the efficacy and safety of SGLT-2 inhibitors in patients with SOT. Among 25 studies, 18 included kidney transplant recipients. There was considerable heterogeneity between the remaining studies regarding design, setting, and outcomes. The meta-analysis of two interventional studies showed the beneficial effects of SGLT-2 inhibitors on body mass index (BMI) (-2.564, 95% CI: -4.982 to -0.146, I²=0%, P=0.0377), weight (-0.800, 95% CI: -0.878 to -0.722, I²=0%, P<0.0001), and hemoglobin A1c (HbA1c) (-0.447, 95% CI: 0.085 to 0.810, I²=0%, P=0.0155) in the kidney transplant population. The mortality benefits of SGLT-2 inhibitors in the kidney transplant population have been shown in observational studies with large sample sizes. Despite the benefits of SGLT-2 inhibitors on metabolic outcomes and their satisfactory safety profiles represented in most eligible studies, these medications should be used with caution in patients with SOT, particularly in high-risk patients. Additional well-designed studies are needed to reveal the efficacy and safety of SGLT-2 inhibitors in patients with SOT.