*Purpose: Posttransplant diabetes mellitus (PTDM) is a major complication after kidney transplantation (KT) often attributable to immunosuppression. The risk of PTDM may increase with more potent steroid maintenance and older recipient age.

*Methods: Using USRDS data, we studied 12,488 adults (age≥18) first-time KT recipients (2010-2015) without diabetes at the time of KT. We compared the risk of PTDM among recipients underwent early steroid withdrawal (ESW) versus those continued steroid maintenance (CSM) using Cox regression with inverse probability weighting to adjust for confounding. We also tested whether the risk of PTDM resulting from CSM differed by recipient age (18-29, 30-54 and 55+ years).

*Results: Of 12,488, 28.3% recipients received ESW. The incidence rate for PTDM was 13 per 100 person-years (11 per 100 person-years in ESW; 14 per 100 person-years in CSM). Overall, ESW was associated with lower risk of PTDM compared with CSM (aHR=_0.720.79_0.86) but the risk differed by recipient age. ESW was associated with lower risk of PTDM among old (aged 55+) recipients (aHR=_0.620.71_0.81), but not among young (aged 18-29) recipients (aHR=_0.811.18_1.72, interaction p=0.01).

*Conclusions: Early immunosuppression strategy should be tailored among old recipients to balance the risks and benefits.

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