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

Table 3 Published evidence and graded strength of evidence on the potential benefit of glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonists on metabolic complications in liver transplant recipients

Metabolic complication	Associated cardiovascular/clinical risk	Potential benefit of glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonist	Evidence level (grade)	Ref.
Post-transplant insulin resistance/type 2 diabetes mellitus	Increased: Risk of MACE, myocardial infarction, stroke, and cardiovascular mortality	Improved glycaemic control, weight reduction, and reduced insulin resistance	Moderate (extrapolated from large RCTs in non-transplant populations)	Kristensen et al[60], Grancini et al[75], Lin et al[82]
Dyslipidaemia	Increased: Atherogenesis, MACE, accelerated atherosclerosis	Improved lipid profile, reduced triglycerides and low-density lipoproteins, and improved endothelial function	Low-moderate (observational in LT, high-quality in non-LT)	Kristensen et al[60], Lin et al[82], Dotan et al[83]
Visceral adiposity/obesity	Increased: Insulin resistance, blood pressure, MACE	Weight reduction, improved body composition, anti-inflammatory effects	Moderate (non-LT RCTs, LT observational)	Kristensen et al[60], Grancini et al[75], Lin et al[82], Dotan et al[83]
Metabolic syndrome (cluster of risk factors)	Increased: Combined cardiovascular risk, long-term mortality	Multifactorial improvement: Weight, glycaemia, blood pressure, lipids, inflammation	Low (transplant-specific RCTs lacking, evidence extrapolated)	Yakubu et al[59], Kristensen et al[60], Grancini et al[75], Lin et al[82], Dotan et al[83]
Pro-inflammatory state/endothelial dysfunction	Increased: Atherosclerosis progression, MACE	Anti-inflammatory effects, improved endothelial function, potential reduction in cardiovascular events	Low (mechanistic, limited clinical transplant data)	Kristensen et al[60], Grancini et al[75], Lin et al[82]

LT: Liver transplantation; MACE: Major adverse cardiovascular events; RCTs: Randomized controlled trials.