*Purpose: In kidney transplantation, immunosuppressive regimens almost always contain corticosteroids for preventing acute rejection and graft loss. However, long-term maintenance of corticosteroids has been associated with co-morbidity, with adverse effects including weight gain, hyperlipidemia, high blood pressure, impaired glucose metabolism and osteoporosis. Although several studies have been conducted to evaluate the efficacy of corticosteroid withdrawal after kidney transplantation, the optimal timing of corticosteroid withdrawal is still remained as a considerable debate because of increased risk of allograft loss and acute rejection. The aim of this study was to evaluate the safety and efficacy of steroid reduction strategy after 6-month post-kidney transplantation.

*Methods: A prospective, multicenter, open-label, single arm study was conducted at 12 transplant centers in Korea. A total sample size was 179 and among these patient, 6-month steroid reduction strategy applied to 65 patients who satisfied the inclusion criteria (no biopsy-proven acute rejection (BPAR) in the first 6-month, no proteinuria, no elevated serum creatinine). This 1-year follow-up study assessed the safety and efficacy of 6-month steroid reduction strategy.

*Results: The mean estimated glomerular filtration rates at 1-year post-transplantation were 65.91 ± 19.62 mL/min/1.73m² in no steroid reduction group and 72.26 ± 19.07 mL/min/1.73m² in steroid reduction group (P=0.037). In the time interval from 6-month to 1-year after transplantation, the incidences of BPAR were 4 (3.5%) in no steroid reduction group and 0 in steroid reduction group. No graft loss and patient death was observed in both groups. There was a small but not statistical difference in HbA1c levels at 1-year between two groups (6.23±1.11 vs 5.92±1.14, P=0.074). In steroid reduction group, there was no incidence of new onset diabetes mellitus after transplantation (NODAT) during 6-month to 1-year post-transplantation.

*Conclusions: In this study, our findings suggest that the strategy of 6-month after steroid reduction in kidney transplantation is safe and effective to the patient with no adverse course in the first 6-month post-transplantation. Additionally, it is expected that a glucose metabolism is improved by steroid reduction strategy without an increase in acute rejection and graft loss rates comparing to steroid maintenance regimen.

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