Redefining weight management after liver transplantation with glucagon-like peptide one and gastric inhibitory polypeptide receptor agonists

Abstract

Obesity is a challenging complication that many liver transplant recipients face. Liver transplantation is the sole life-saving procedure in many end-stage liver diseases, but the underlying pathology, in addition to some immunosuppressive regimens, may worsen the metabolic status of many patients. A comprehensive management plan to prevent further metabolic complications, like metabolic dysfunction-associated steatotic liver disease, chronic renal dysfunction, and diabetes, is essential to obtain a favourable prognosis and a better quality of life. glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists have been approved for long-term weight management by the United States Food and Drug Administration and other regulatory authorities. While this pharmacotherapeutic intervention revolutionised obesity management, it comes with many limitations. Their long-term safety profile, optimal dosing, duration of treatment and outcomes are still insufficiently studied, specifically in the transplant recipient population. This review aims to explore the pathophysiology, risk factors, clinical presentation, and burden of metabolic complications in liver transplant recipients and to review available data on the potential use of GLP-1 and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists in mitigating these complications among this vulnerable population.

Keywords: Liver transplantation; Obesity; Metabolic syndrome; Steatosis; Weight loss

Core Tip: While liver transplantation can be life-saving for end-stage liver diseases, it can exacerbate metabolic issues due to underlying pathology and immunosuppressive regimens. A thorough management plan is essential to prevent complications like metabolic dysfunction-associated steatotic liver disease, chronic renal dysfunction, and diabetes, ultimately improving prognosis and quality of life. glucagon-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists have gained United States Food and Drug Administration approval for long-term weight management, but their long-term safety, optimal dosing, and effectiveness in transplant recipients remain underexplored. This review addresses the pathophysiology, risk factors, and burden of metabolic complications in liver transplant recipients while evaluating the potential role of GLP-1 and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists for managing these issues.