Safety and efficacy of tirzepatide in transplant recipients: a systematic review and meta-analysis

Introduction Tirzepatide has demonstrated cardiovascular and metabolic benefits in the general population; however, evidence in post-transplant patients is very limited. The aim of this systematic review and meta-analysis is to evaluate the safety and efficacy of tirzepatide in solid organ transplant recipients. Methods We searched PubMed-MEDLINE, Embase, and Cochrane Library databases. All randomized controlled trials (RCTs) and observational studies were considered. Efficacy outcomes included improvements to glycemic outcomes demonstrated by reductions to hemoglobin A1c and changes to weight, measured by body mass index. Safety was assessed through patients who discontinued tirzepatide treatment due to adverse drug reactions. Results No randomized controlled trials (RCTs) or other interventional clinical trials were identified in the available literature. Four non-randomized observational studies were found and included. Using the Weighted Median of the Difference of Medians statistical test, tirzepatide was associated with absolute reductions in hemoglobin A1c of −1.4% (95% CI: −1.7 to −0.4) and body mass index of −1.2 kg/m 2 (95% CI: −5.9 to −1.1) in solid organ transplant recipients. Pooled proportions indicated a tirzepatide discontinuation rate of 3.1% (95% CI: 0.0–7.1) due to adverse drug reactions, suggesting the therapy was well tolerated in this population. Conclusion Tirzepatide was associated with reductions in hemoglobin A1c and body mass index and was generally well tolerated in solid organ transplant recipients. These findings suggest a potential role for tirzepatide in the management of obesity and post-transplant diabetes mellitus, pending confirmation in larger prospective studies. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251154851 , identifier CRD420251154851.