3 Key Takeaways
Plain English Summary- 01Core Finding
We randomized adult heart transplant recipients with an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m ² at least one year after transplantation 1:1 to receive dapagliflozin 10 mg or matching placebo (inactive comparison treatment) once daily.
- 02Study Evidence
Tested in a randomized controlled trial (430 participants) at the randomized clinical trial stage.
- 03Practical Meaning
Controlled trial findings show causal benefit under protocol rules; real-world effectiveness can vary across patients.
What This Means for You
In heart transplant recipients, dapagliflozin, compared with placebo (inactive comparison treatment), improved the slope of the eGFR from 2 weeks to 12 months of treatment.
The Discovery
Progressive kidney disease is common in heart transplant recipients due to calcineurin inhibitor exposure and pre-existing comorbidities. Sodium-glucose cotransporter-2 (SGLT2) inhibitors may attenuate the decline in kidney function, but evidence in heart transplant recipients is limited.
The DAPAgliflozin for Renal protection in Heart Transplant recipients (DAPARHT) trial is a multicenter, double-blind, randomized, placebo (inactive comparison treatment)-controlled trial conducted at six heart transplant centers in Northern Europe. We randomized adult heart transplant recipients with an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m ² at least one year after transplantation 1:1 to receive dapagliflozin 10 mg or matching placebo once daily. The primary endpoint was the slope of the eGFR from 2 weeks after treatment initiation to the end of the 12-month blinded treatment period.
Between June 2022 and September 2025, we randomized 430 participants, of whom 217 were allocated to dapagliflozin and 213 were allocated to placebo (inactive comparison treatment). We included the 424 patients with at least one eGFR measurement after baseline in the full analysis set. Their mean age was 53 ± 14 years and 29& were women. The eGFR at baseline was 67 ± 22 mL/min/1.73 m 2 . The median time from transplantation was 7 (3 - 13) years. Dapagliflozin improved the chronic slope of the eGFR compared with placebo. The change in the eGFR from 2 weeks to 12 months after treatment initiation was 2.0 (95% confidence interval [CI] 1.0 - 3.1) mL/min/1.73 m 2 in the dapagliflozin group and 0.3 (95% CI -0.8 - 1.4) mL/min/1.73 m 2 in the placebo group for a between-group difference of 1.7 (95% confidence interval 0.1 - 3.3) mL/min/1.73 m ² ; p = 0.03. There were no unexpected safety signals and similar rates of adverse events, including infections, between groups.
How It Works, Simply
This cardiology research focuses on cardiovascular hemodynamic & lipid pathway modulation. Researchers evaluated it using a randomized controlled trial (430 participants) at the randomized clinical trial stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
We randomized adult heart transplant recipients with an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m ² at least one year after transplantation 1:1 to receive dapagliflozin 10 mg or matching placebo once daily.
- 02Study Evidence
Tested in a randomized controlled trial (430 participants) at the randomized clinical trial stage.
- 03Practical Meaning
Controlled trial findings show causal benefit under protocol rules; real-world effectiveness can vary across patients.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Randomized controlled trial
Randomized controlled trial (430 participants) · Randomized Clinical Trial
Biological Pathway & Modality
Cardiovascular hemodynamic & lipid pathway modulation
Intervention: Dapagliflozin for Renal Protection in Heart Transplant Recipients: A Randomized
Experimental Findings & Endpoints
Progressive kidney disease is common in heart transplant recipients due to calcineurin inhibitor exposure and pre-existing comorbidities.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors may attenuate the decline in kidney function, but evidence in heart transplant recipients is limited.
The DAPAgliflozin for Renal protection in Heart Transplant recipients (DAPARHT) trial is a multicenter, double-blind, randomized, placebo-controlled trial conducted at six heart transplant centers in Northern Europe. We randomized adult heart transplant recipients with an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m ² at least one year after transplantation 1:1 to receive dapagliflozin 10 mg or matching placebo once daily.
The primary endpoint was the slope of the eGFR from 2 weeks after treatment initiation to the end of the 12-month blinded treatment period.
Between June 2022 and September 2025, we randomized 430 participants, of whom 217 were allocated to dapagliflozin and 213 were allocated to placebo. We included the 424 patients with at least one eGFR measurement after baseline in the full analysis set.
Their mean age was 53 ± 14 years and 29& were women. The eGFR at baseline was 67 ± 22 mL/min/1.73 m 2 .
The median time from transplantation was 7 (3 - 13) years. Dapagliflozin improved the chronic slope of the eGFR compared with placebo.
The change in the eGFR from 2 weeks to 12 months after treatment initiation was 2.0 (95% confidence interval [CI] 1.0 - 3.1) mL/min/1.73 m 2 in the dapagliflozin group and 0.3 (95% CI -0.8 - 1.4) mL/min/1.73 m 2 in the placebo group for a between-group difference of 1.7 (95% confidence interval 0.1 - 3.3) mL/min/1.73 m ² ; p = 0.03. There were no unexpected safety signals and similar rates of adverse events, including infections, between groups.
Clinical Translation & Practice Context
In heart transplant recipients, dapagliflozin, compared with placebo, improved the slope of the eGFR from 2 weeks to 12 months of treatment.
The Bottom Line · Clinical Pearl
“In heart transplant recipients, dapagliflozin, compared with placebo, improved the slope of the eGFR from 2 weeks to 12 months of treatment.”
Published in Circulation · Current Stage: Randomized Clinical Trial
