Clinical outcomes of glucagon-like peptide-1 receptor agonist therapy in kidney transplant recipients: a systematic review and meta-analysis

ABSTRACT Background Metabolic complications after kidney transplantation (KT) significantly affect graft and patient survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardio-renal benefits in the general population, but evidence in KT recipients remains limited. Methods We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines (PROSPERO: CRD420251153352). PubMed, Scopus, Web of Science, Ovid MEDLINE, and Cochrane Library were searched up to September 2025 for studies evaluating GLP-1RA therapy in adult KT recipients. Random-effects models pooled outcomes for metabolic, renal, cardiovascular, and safety endpoints. Results Seventeen studies (n = 54 680 KT recipients) were included. GLP-1RAs use significantly reduced all-cause mortality (HR 0.53, 95% CI 0.36–0.79, k = 4) and major adverse cardiovascular events (OR 0.55, 95% CI 0.47–0.66, k = 3). Estimated glomerular filtration rate (eGFR) remained stable at 3 months, improved at 6 months (+1.99 ml/min/1.73 m², 95% CI 0.52–3.47, k = 5) and 12 months (+2.24 ml/min/1.73 m², 95% CI 0.02–4.46, k = 6), and was preserved at 24 months. GLP-1RAs lowered HbA1c (MD −0.54%, 95% CI −0.89 to −0.19, k = 13) and body mass index (SMD −0.32, 95% CI −0.49 to −0.15, k = 12) from baseline, with parallel reductions in insulin requirement and urinary albumin excretion. Tacrolimus levels were unaffected at 6 months and modestly decreased at 1 year without compromising graft function. Adverse events were mainly mild gastrointestinal intolerance (10%–20%), with rare discontinuations and no increased risk of hypoglycemia, pancreatitis, or infections. Conclusion GLP-1RAs are associated with improved glycemic control, weight, and cardiovascular outcomes, with no consistent signal of adverse effects on graft stability and immunosuppressive balance. GLP-1RA integration into individualized post-transplant care may be considered for patients with diabetes or metabolic syndrome, with close clinical monitoring.