(90) Transplant readiness achieved through novel solutions for obesity reduction and management

Background: : One of the prevailing trends in the managed care space is GLP-1 hyper-utilization. This trend of utilizing high-cost medication for a relatively broad patient population poses potential concerns for the future. With increasing need to balance access with affordability, research needs to be conducted to understand the clinical value of these types of therapies. In addition, obesity prevalence among transplant candidates is increasing and poses an increased risk for complications post-transplant. Patients with obesity are less likely to be referred, waitlisted, and transplanted and these disparities are especially prevalent among minorities. Options for pre-transplant weight loss include diet, exercise, and bariatric surgery. With incretin-based therapies (IBT) such as GLP-1 receptor agonists (GLP1-RA) and dual GLP-1RA/glucose-dependent insulinotropic polypeptide (GLP-1RA/GIP) agonists, there are now more options for pre-transplant weight loss.

Objective: : This study aims to compare the early effectiveness and value of IBT in pre-transplant patients initiating IBT versus those that did not initiate IBT.

Methods: : This was a single-center, retrospective cohort study of adult patients referred to the TRANSFORM clinic for pre-transplant weight loss from 1/2024 to 12/2024 and started on IBT in addition to diet and exercise recommendations. The primary descriptive endpoint was the percent (%) weight loss from baseline. Secondary endpoints included BMI reduction from baseline, dialysis-free survival, dialysis-free, patient survival, and organ transplant.

Results: : This analysis included pre-transplant patients that initiated IBT (n=41) and pre-transplant patients that did not initiate IBT (n=34). The off-IBT group had a significantly lower EPTS at baseline and significantly fewer insurance approvals overall. At the date of analysis, patients on IBT lost an average of 9.65% body weight compared to 0.33% body weight for those that did not receive IBT (P < 0.001). BMI reduction was 3.9 kg/m2 in the IBT group versus 0.15 kg/m2 in the off-IBT group (P < 0.001). Despite the significant difference in EPTS at baseline, patient survival, dialysis-free survival, and organ transplant at 6 months were similar between groups.

Conclusions: : Early analysis of IBT for pre-transplant weight loss reveals promising results in % weight loss and BMI reduction but is less clear with respect to overall transplant outcomes. Longer follow-up studies are needed to assess further effectiveness and value. IBT could be an important tool for increasing access to successful organ transplantation for patients with obesity.

Sponsorship:: None