Effect of Early Steroid Withdrawal on Posttransplant Diabetes Among Kidney Transplant Recipients Differs by Recipient Age

Background. Posttransplant diabetes (PTD), a major complication after kidney transplantation (KT), is often attributable to immunosuppression. The risk of PTD may increase with more potent steroid maintenance and older recipient age. Methods. Using United States Renal Data System data, we studied 12 488 adult first-time KT recipients (2010-2015) with no known pre-KT diabetes. We compared the risk of PTD among recipients who underwent early steroid withdrawal (ESW) versus continued steroid maintenance (CSM) using Cox regression with inverse probability weighting to adjust for confounding. We tested whether the risk of PTD resulting from ESW differed by recipient age (18-29, 30-54, and >= 55 y). Results. Of 12 488, 28.3% recipients received ESW. The incidence rate for PTD was 13 per 100 person-y and lower among recipients who received ESW (11 per 100 person-y in ESW; 14 per 100 person-y in CSM). Overall, ESW was associated with lower risk of PTD compared with CSM (adjusted hazard ratio [aHR] = (0.72)0.79(0.86)), but the risk differed by recipient age (P-interaction = 0.09 for comparison between recipients aged 18-29 and those aged 30-54; P-interaction = 0.01 for comparison between recipients aged 18-29 and those aged >= 55). ESW was associated with lower risk of PTD among recipients aged >= 55 (aHR = (0.62)0.71(0.81)) and those aged 30-54 (aHR = (0.73)0.83(0.95)), but not among recipients aged 18-29 (aHR = (0.81)1.18(1.72)). Although recipients who received ESW had a higher risk of acute rejection across the age groups (adjusted odds ratio = (1.01)1.17(1.34)), recipients with no PTD had a lower risk of mortality (aHR = (0.58)0.66(0.74)). Conclusions. The beneficial association of ESW with decreased PTD was more pronounced among recipients aged >= 55, supporting an age-specific assessment of the risk-benefit balance regarding ESW.