{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:06:54Z","timestamp":1771999614619,"version":"3.50.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>\n                    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\n                    <jats:italic>de-novo<\/jats:italic>\n                    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\u00a0months significantly reduced PTDM risk (HR = 0.586; 95% CI = 0.407\u20130.846\u00a0at 1\u00a0month, HR = 0.766; 95% CI = 0.611\u20130.960 at 3\u00a0month), whereas withdrawal after 3\u00a0months showed no significant benefit (HR = 0.844; 95% CI = 0.619\u20131.152\u00a0at 6\u00a0month). 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.\n                  <\/jats:p>","DOI":"10.3389\/ti.2026.15432","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T06:10:21Z","timestamp":1770876621000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Clinical Impact of Early Steroid Withdrawal on Diabetes Mellitus After Liver Transplantation: A Population-Based Cohort Study"],"prefix":"10.3389","volume":"39","author":[{"given":"Haeseon","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pharmacotherapy, College of Pharmacy, University of Utah","place":["Salt Lake City, UT, United States"]},{"name":"Institute of Regulatory Innovation Through Science (IRIS), Kyung Hee University","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YoungRok","family":"Choi","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital, College of Medicine, Seoul National University","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hae Sun","family":"Suh","sequence":"additional","affiliation":[{"name":"Institute of Regulatory Innovation Through Science (IRIS), Kyung Hee University","place":["Seoul, Republic of Korea"]},{"name":"College of Pharmacy, Kyung Hee University","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1888","DOI":"10.1056\/NEJMra2200923","article-title":"Liver Transplantation","volume":"389","author":"Lucey","year":"2023","journal-title":"New Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1111\/ajt.16978","article-title":"OPTN\/SRTR 2020 Annual Data Report: Liver","volume":"22","author":"Kwong","year":"2022","journal-title":"Am J Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/lt.23566","article-title":"Long-Term Management of the Successful Adult Liver Transplant: 2012 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation","volume":"19","author":"Lucey","year":"2013","journal-title":"Liver Transpl"},{"key":"B4","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1002\/lt.26325","article-title":"Redefining Success After Liver Transplantation: From Mortality Toward Function and Fulfillment","volume":"28","author":"Serper","year":"2022","journal-title":"Liver Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/TP.0000000000001651","article-title":"Practical Recommendations for Long-Term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group","volume":"101","author":"Neuberger","year":"2017","journal-title":"Transplantation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1210\/js.2018-00227","article-title":"Hyperglycemia in the Posttransplant Period: NODAT vs Posttransplant Diabetes Mellitus","volume":"2","author":"Gupta","year":"2018","journal-title":"J Endocr Soc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1097\/tp.0000000000004875","article-title":"Minimizing Metabolic and Cardiac Risk Factors to Maximize Outcomes After Liver Transplantation","volume":"108","author":"Schmidt","year":"2024","journal-title":"Transplantation"},{"key":"B8","doi-asserted-by":"crossref","DOI":"10.1016\/j.mayocp.2012.02.021","article-title":"Long-Term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know","volume-title":"Mayo Clinic Proceedings","author":"Singh","year":"2012"},{"key":"B9","doi-asserted-by":"publisher","first-page":"85","DOI":"10.3390\/livers2020006","article-title":"A Comprehensive Review on the Risk of Metabolic Syndrome and Cardiovascular Disease After Liver Transplantation","volume":"2","author":"Chauhan","year":"2022","journal-title":"Livers"},{"key":"B10","doi-asserted-by":"publisher","first-page":"101681","DOI":"10.1016\/j.bpg.2020.101681","article-title":"Immunosuppression in Liver Transplant","volume":"46","author":"Di Maira","year":"2020","journal-title":"Best Pract & Res Clin Gastroenterol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/TP.0000000000002147","article-title":"International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients","volume":"102","author":"Charlton","year":"2018","journal-title":"Transplantation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1002\/cld.992","article-title":"Steroid\u2010Free Versus Steroid\u2010Containing Immunosuppression for Liver Transplant Recipients","volume":"16","author":"Fairfield","year":"2020","journal-title":"Clin Liver Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1097\/00007890-200008150-00001","article-title":"Steroid Withdrawal in Liver Transplantation: Benefits, Risks, and Unanswered Questions","volume":"70","author":"Reding","year":"2000","journal-title":"Transplantation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1900\/RDS.2012.9.6","article-title":"Genetic and Environmental Factors Associated with Type 2 Diabetes and Diabetic Vascular Complications","volume":"9","author":"Murea","year":"2012","journal-title":"The Review Diabetic Studies: RDS"},{"key":"B15","volume-title":"International Registry in Organ Donation and Transplantation","year":"2023"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e2014008","DOI":"10.4178\/epih\/e2014008","article-title":"A Guide for the Utilization of Health Insurance Review and Assessment Service National Patient Samples","volume":"36","author":"Kim","year":"2014","journal-title":"Epidemiol Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3350\/cmh.2017.0066","article-title":"Current Epidemiology and Clinical Characteristics of Autoimmune Liver Diseases in South Korea","volume":"24","author":"Jeong","year":"2018","journal-title":"Clin Mol Hepatol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"CD002243","DOI":"10.1002\/14651858.CD002243.pub4","article-title":"Corticosteroids for Treating Sepsis in Children and Adults","volume":"12","author":"Annane","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration","volume":"4","author":"Vandenbroucke","year":"2007","journal-title":"Plos Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1093\/eurheartj\/ehr031","article-title":"An Overview of the Objectives of and the Approaches to Propensity Score Analyses","volume":"32","author":"Heinze","year":"2011","journal-title":"Eur Heart Journal"},{"key":"B21","doi-asserted-by":"publisher","first-page":"6329","DOI":"10.3748\/wjg.v21.i20.6329","article-title":"Risk Factors for New Onset Diabetes Mellitus After Liver Transplantation: A Meta-Analysis","volume":"21","author":"Li","year":"2015","journal-title":"World J Gastroenterol WJG"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e14523","DOI":"10.1111\/dme.14523","article-title":"Association of British Clinical Diabetologists and Renal Association Guidelines on the Detection and Management of Diabetes Post Solid Organ Transplantation","volume":"38","author":"Chowdhury","year":"2021","journal-title":"Diabetic Med"},{"key":"B23","unstructured":"Liver Transplantation and New Life: The Korean Society for Transplantation\n          \n          \n            \n              Park\n              J\n            \n            \n              Joo\n              D\n            \n            \n              Kim\n              J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e14340","DOI":"10.1111\/ctr.14340","article-title":"Systematic Review and Meta-Analysis of Post-Transplant Diabetes Mellitus in Liver Transplant Recipients","volume":"35","author":"Lawendy","year":"2021","journal-title":"Clin Transpl"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.3904\/kjim.2019.292","article-title":"Characteristics of Kidney Transplantation Recipients over Time in South Korea","volume":"35","author":"Park","year":"2020","journal-title":"The Korean J Intern Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"CD007606","DOI":"10.1002\/14651858.CD007606.pub4","article-title":"Glucocorticosteroid\u2010Free Versus Glucocorticosteroid\u2010Containing Immunosuppression for Liver Transplanted Patients","volume":"4","author":"Fairfield","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"B27","doi-asserted-by":"publisher","first-page":"238","DOI":"10.14701\/ahbps.23-129","article-title":"Safety and Efficacy of Early Corticosteroid Withdrawal in Liver Transplant Recipients: A Randomized Controlled Trial","volume":"28","author":"Kim","year":"2024","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1038\/mi.2008.27","article-title":"Immune Privilege or Privileged Immunity?","volume":"1","author":"Forrester","year":"2008","journal-title":"Mucosal Immunol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"185","DOI":"10.2147\/clep.S129879","article-title":"Confounding in Observational Studies Based on Large Health Care Databases: Problems and Potential Solutions - A Primer for the Clinician","volume":"9","author":"N\u00f8rgaard","year":"2017","journal-title":"Clin Epidemiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"vi8","DOI":"10.1093\/ndt\/gfh1063","article-title":"Evaluating Mechanisms of Post-Transplant Diabetes Mellitus","volume":"19","author":"Van Hooff","year":"2004","journal-title":"Nephrol Dial Transplant"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e15441","DOI":"10.1111\/dme.15441","article-title":"Association of Early Post-Transplant Hyperglycaemia and Diabetes Mellitus on Outcomes Following Heart Transplantation","volume":"42","author":"Muir","year":"2025","journal-title":"Diabet Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1210\/clinem\/dgab697","article-title":"Early Post-Renal Transplant Hyperglycemia","volume":"107","author":"Iqbal","year":"2021","journal-title":"The J Clin Endocrinol & Metab"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15432\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:04:18Z","timestamp":1771995858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15432\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":32,"alternative-id":["10.3389\/ti.2026.15432"],"URL":"https:\/\/doi.org\/10.3389\/ti.2026.15432","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"article-number":"15432"}}