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

## TL;DR

Withdrawing steroids within three months after liver transplant reduces the risk of developing diabetes without harming graft function, according to a large Korean study.

## Contribution

This study provides population-based evidence that early steroid withdrawal reduces post-transplant diabetes risk without increasing rejection.

## Key findings

- Steroid withdrawal within 3 months significantly lowers the risk of post-transplant diabetes mellitus.
- Withdrawal after 3 months shows no significant benefit in reducing diabetes risk.
- Rejection events were rare, indicating no major compromise in graft function with early steroid withdrawal.

## Abstract

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 de-novo 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.

Infographic summarizing a nationwide Korean cohort study from 2009 to 2021 on early steroid withdrawal after liver transplant. Methods include comparing steroid maintenance versus withdrawal at one, three, and six months. Results show steroid withdrawal within three months reduces post-transplant diabetes mellitus risk without affecting graft safety, while withdrawal at six months provides no benefit. Study includes 6,295 recipients, mostly living donor transplants, with primary outcome incidence of post-transplant diabetes mellitus.