Background <p>Posttransplant diabetes mellitus (PTDM) is associated with reduced patient survival and death-censored graft survival and has been linked to steroid use and obesity. 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.</p> Methods <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 &lt; 0.05 was considered to indicate statistical significance.</p> Results <p>There was no difference in patient or graft survival among those with PTDM, preexisting diabetes or no diabetes. 16% (<i>n</i> = 55) developed PTDM over a median follow-up of 7.1 years (range: 0.9–13.8 years). After adjusting for confounding factors, the odds of PTDM diagnosis were associated with increasing BMI (odds ratio (OR): 1.01; 95% CI: 1.03–1.18), and white ethnicity was associated with reduced odds of PTDM (OR: 0.45; 95% CI: 0.23–0.90).</p> Conclusions <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.</p> Clinical trial number <p>Not applicable.</p>