I need to check the literature first but my intuition is I would not mind as long as there is no noted infections given the immune compromised status and  anti rejections use in transplant recipients, yet I would stop it with any UTI.

i will use insulin as physiological hormone for eutrophy and anti-arteriosclerotic agent.

I have no personal experience. There is probably no large trial. But question is very interesting. Three issues with its use. Wheather it can increase UTI specially with fungal infection in immunocompromised state?. Any drug interaction specially with cyclosporin? As these drugs had already shown benefit in reducing the progress of CKD in diabetes wheather they had got any beneficial role in term of renal rejection? Lastly cardio vascular mortality benefit is also seen in post transplant patient? An well designed study is needed to get these answar. I think this drug has good prospect in this regard.. Thanks 

to my knowledge there are no trials in diabetic patients with kidney transplant  but  I have read some articles of basic research where the rodent models developed diabetic nephropathy and they where treated with SGLT2 Inhibitors. The data suggests a renoprotective effect of SGLT2 inhibitors in T2 diabetic mice. Here are the references.

• Gembardt F. et al. (2014) The SGLT2 inhibitor empagliflozin ameliorates early features of diabetic nephropathy in BTBR ob/ob type 2 diabetic mice with and without hypertension. Am J Physiol Renal Physiol 307: F317–F325.

• Terami N, Ogawa D, Tachibana H, Hatanaka T, Wada J, et al. (2014) Long-Term Treatment with the Sodium Glucose Cotransporter 2 Inhibitor, Dapagliflozin, Ameliorates Glucose Homeostasis and Diabetic Nephropathy in db/db Mice. PLoS ONE 9(6): e100777. doi:10.1371/journal.pone.0100777

I don't have any experience on CKD treatment in diabetic patients but I would use SGLT2 inhibitors instead of insulin for the following theoretical reason. Hyperglycemia as well as hyperinsulinemia are potent stimulants of inflammation in the kidney which could further increase the inflammatory response of the already injured kidney transplant. Typically, T2 diabetic patients are insulin resistant which does not mean that they are also resistant to the inflammatory response. Therefore, the use of SGLT2 inhibitors, instead of insulin could decrease the noxious stimuli of hyperglycemia as well as insulin resistance attenuating the progression of CKD. 

Hope it has been helpful

I have no personal experience and am unaware of controlled studies in transplanted patients. A special care regarding urogenital infections in an immuno-compromised patient is needed, especially as distorted anatomy of the collecting system of the transplanted kidney, and declined flow in the native collecting systems might predispose to ascending infections. In addition, there might be a risk of co-administered SGLT2 inhibitors with calcineurin inhibitors due to a potential combined hypoxic insult to the renal medulla (diabetes care  40:e40-1, 2017)

http://care.diabetesjournals.org/content/diacare/early/2017/04/03/dc17-0237.full.pdf

I am not aware of their use in kidney transplantation, but, please, find enclosed a study from a group particularly expert in proteinuria in in diabetic and non diabetic patients

Many Thanks to all colleagues for their answers. I enjoyed reading each and every one of them.

While plorizin normoglycemia normalized functions without further glomerular damage in STZ diabetic rats, insulin normalized glycemia and renal functions but promoted glomerular mesangial expansion. So less problem with the sglt2 inhibitor than with insulin treatment.

We are running a trial i RenalTx patents using an SLGT2 inhibitor and it looks to be safe in the interim analysis.

Thank you

I wonder if any of the clinicians reading this are interested in helping answer this question by participating in this survey that I running.  It will only take a couple of minutes. Please click on the link:

https://www.surveymonkey.com/r/VSJ6TYZ

Dr Asberg: do you have any followup from the study you were running on SGLT2 inhibitors in transplant patients?

Not yet, finalized by summer this year.

Use of SGLT2 Inhibitors in Diabetic Renal Transplant Recipients: A Mixed Method Exploratory Exercise

September 2018International Journal of Diabetes and Metabolism 21(1-4):16-21

DOI: 10.1159/000492758

LicenseCC BY-NC-ND 4.0

Salem A BeshyahSalem A BeshyahAnas S BeshyahAnas S BeshyahWaleed S BeshyahWaleed S BeshyahSalim YaghiSalim Yaghi