Real-World Evidence for Metformin Use in Solid Organ Transplant Recipients Living With Diabetes
Authors' conclusion
In SOT recipients living with diabetes, metformin use was associated with improved survival, cardiovascular and renal outcomes, and favorable metabolic effects without compromising safety. These findings support the cautious use of metformin in selected transplant recipients. Prospective studies are warranted.
Study context
- Population
- Adult solid organ transplant (SOT) recipients (kidney, liver, lung, heart) with pre-existing T2D, large health care organization
- Participants
- 938 matched patients
- Exposure
- Metformin use vs no metformin
- Outcome
- MACE, HF, all-cause mortality and severe renal dysfunction (eGFR ≤15 mL/min/1.73 m²)
Methodological details1:1 matched by age, sex and organ type, real-world
- 1:1 matched by age, sex and organ type
- Real-world
Main finding
As reported in the abstract
Each group vs nonusersEstimate (95% CI)P value
Metformin
aHR (MACE) 0.77(0.61–0.98)
P = 0.031Metformin
HR (all-cause mortality) 0.52(0.38–0.71)
P < 0.001Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Graft dysfunction in kidney recipients (eGFR <15 mL/min/1.73 m², dialysis, kidney biopsy or rejection) | 0.59 (0.45–0.77) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Glycemic and lipid parameters
- Glycemic and lipid parameters improved significantly in metformin users
Safety
- No increased risk of lactic acidosis
Original publication
Real-World Evidence for Metformin Use in Solid Organ Transplant Recipients Living With Diabetes. Endocr Pract. Published 13 November 2025. doi:10.
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