Comparative Analysis of Efficacy and Safety of the Glucagon-Like-Peptide-1 Receptor Agonists Tirzepatide and Semaglutide in Solid-Organ Transplant Recipients.

OBJECTIVES: Diabetes mellitus, including new-onset diabetes after transplant, is a prevalent complication in solid-organ transplant recipients, often necessitating complex glycemic management. Glucagon-like peptide-1 receptor agonists, including semaglutide and tirzepatide, have shown promising outcomes in the general population, but comparative data in solid-organ transplant recipients are limited. In this study, we evaluated and compared the efficacy and safety of semaglutide and tirzepatide in a diverse cohort of solid-organ transplant recipients. MATERIALS AND METHODS: This retrospective chart review study involved 73 solid-organ transplant recipients treated with semaglutide (n = 39) or tirzepatide (n = 34) at a quaternary care center in the United Arab Emirates. Efficacy endpoints included changes in weight, body mass index, hemoglobin A1c, fasting plasma glucose, insulin requirements, and serum triglycerides. As safety outcomes, we assessed adverse effects, immunosuppressant levels, and allograft function. RESULTS: Both agents significantly improved weight, body mass index, hemoglobin A1c, fasting plasma glucose, and triglyceride levels. Tirzepatide led to a greater reduction in median triglyceride levels compared with semaglutide, despite a significantly shorter treatment duration. Adverse events were more frequent in the semaglutide group, including gastrointestinal intolerance and infections, despite being confounded by disparities in follow-up duration. No significant changes in tacrolimus levels, graft function, or mortality were observed in either group. CONCLUSIONS: Tirzepatide and semaglutide were shown to be both effective and generally safe for mana-gement of diabetes mellitus in solid-organ transplant recipients. Tirzepatide may offer advantages in tolerability and rapid glycemic control. Prospective studies are warranted to confirm these findings in larger, controlled cohorts.