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Steroid avoidance regimens have been associated with a reduction in PTDM without impacting patient or graft survival followed up for 5 years following kidney transplantation; however, acute rejection remains a concern. The primary objective of this study was to assess death-censored graft and patient survival outcomes and report on PTDM onset in patients receiving steroid-avoidance immunosuppressant regimens over 11 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study from a single center in the UK that included first kidney transplants between 2010 and 2021. Logistic regression models and Cox proportional hazards models were used to investigate associations between survival and PTDM. A P value\u2009&lt;\u20090.05 was considered to indicate statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was no difference in patient or graft survival among those with PTDM, preexisting diabetes or no diabetes. 16% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200955) developed PTDM over a median follow-up of 7.1 years (range: 0.9\u201313.8 years). After adjusting for confounding factors, the odds of PTDM diagnosis were associated with increasing BMI (odds ratio (OR): 1.01; 95% CI: 1.03\u20131.18), and white ethnicity was associated with reduced odds of PTDM (OR: 0.45; 95% CI: 0.23\u20130.90).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings support lower PTDM rates and safe longer-term outcomes following a steroid-free regimen. Timely weight management interventions before transplantation, particularly in high-risk groups, may reduce PTDM in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-025-04419-2","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T08:45:16Z","timestamp":1758876316000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Posttransplant diabetes mellitus and long-term outcomes after kidney transplantation in a steroid avoidance regimen: a cohort study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6999-8230","authenticated-orcid":false,"given":"Claire","family":"Gardiner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Keane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lenfant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Tankisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle Hiu Ching","family":"Yam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Daga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"4419_CR1","unstructured":"UK Renal Registry UK Renal Registry 25th Annual Report \u2013 data to 31\/12\/2021, Bristol, UK. 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NHS national data opt-outs: trends and potential consequences for health data research."}],"container-title":["BMC Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-025-04419-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12882-025-04419-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-025-04419-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:35:30Z","timestamp":1781609730000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12882-025-04419-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4419"],"URL":"https:\/\/doi.org\/10.1186\/s12882-025-04419-2","relation":{"references":[{"id-type":"doi","id":"10.3399\/BJGPO.2024.0020","asserted-by":"subject"}]},"ISSN":["1471-2369"],"issn-type":[{"value":"1471-2369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"assertion":[{"value":"11 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval for this study was granted by Leeds Beckett University Ethics Committee. Information governance approval was obtained through a local regulatory process (Data Access Committee at Leeds Teaching Hospitals Trust, 03\/12\/2020; LTH20072_DR3). According to UK law and Health Research Authority guidance, informed consent was not required for research using anonymised data. Informed consent was not obtained as the previously collected data were fully anonymised and used for secondary analysis only. We excluded data for individuals who opted out via the NHS National Data Opt-Out service.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent for publication"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"520"}}