The Clinical Impact of Early Steroid Withdrawal on Diabetes Mellitus After Liver Transplantation: A Population-Based Cohort Study

Despite the metabolic risks associated with corticosteroids after liver transplantation (LT), the optimal timing for their withdrawal remains uncertain due to limited and inconsistent evidence. To evaluate the impact of corticosteroid withdrawal timing on the development of <i>de-novo</i> post-transplant diabetes mellitus (PTDM), we performed a retrospective cohort study of 6,295 adult recipients who underwent LT between 2009 and 2021 in South Korea, utilizing a national health insurance claims database. A landmark analysis with time-varying propensity score matching was conducted at one-, three-, and six-month post-transplantation to compare the incidence of PTDM between steroid withdrawal and maintenance groups. Early steroid withdrawal within 3 months significantly reduced PTDM risk (HR = 0.586; 95% CI = 0.407-0.846 at 1 month, HR = 0.766; 95% CI = 0.611-0.960 at 3 month), whereas withdrawal after 3 months showed no significant benefit (HR = 0.844; 95% CI = 0.619-1.152 at 6 month). Rejection events were rare, suggesting no substantial compromise in graft function. These findings indicate that corticosteroid withdrawal within the first three months post-LT can lower the risk of PTDM without increasing rejection risk, supporting timely steroid tapering as part of post-transplant immunosuppressive strategies to reduce long-term metabolic complications.