skip to main content

SGLT2i Post-Transplant Specific Concerns — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateTransplantationSGLT2i Post-Transplant Specific ConcernsESENeph

A kidney transplant recipient on Tacrolimus develops post-transplant diabetes (PTDM). His HbA1c is 55 mmol/mol. He is started on Dapagliflozin for dual glycaemic and renal benefit. What specific transplant-related concern exists with SGLT2i use?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Increased risk of UTI and genital infections in an immunosuppressed patient; potential for volume depletion affecting Tacrolimus levels; limited RCT data specific to transplant recipients – though observational data supports safety; close monitoring is recommended

While SGLT2i has strong evidence in native CKD, transplant recipients were excluded from major trials (DAPA-CKD, EMPA-KIDNEY). Transplant-specific concerns include: increased UTI/genital infection risk (already elevated from immunosuppression), volume depletion potentially affecting Tacrolimus absorption/levels, and euglycaemic DKA risk with concurrent steroids. However, observational data and small studies (e.g. Halden et al 2019) suggest SGLT2i is safe and effective post-transplant. KDIGO 2024 acknowledges their potential role. Monitoring should include Tacrolimus levels after SGLT2i initiation.

Reference: KDIGO 2024 – CKD; Halden et al 2019 – SGLT2i Post-Transplant