{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:08:28Z","timestamp":1785802108228,"version":"3.56.0"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kidney transplant recipients (KTRs) are at elevated risk for metabolic syndrome (MS), primarily due to the side effects of immunosuppressive therapy. Emerging evidence suggests that MS may be associated with adverse outcomes such as cardiovascular disease (CVD), reduced graft function, and graft loss. This review aims to evaluate the association between MS and cardio\u2010renal outcomes in KTRs, specifically its impact on the incidence of cardiovascular events, all\u2010cause mortality, graft failure, and acute graft rejection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a comprehensive search in MEDLINE, EMBASE, and CENTRAL databases from inception to August 2024. No language restrictions were applied. Two reviewers independently screened articles, extracted data, and assessed study quality. Meta\u2010analyses were conducted using fixed\u2010effect or random\u2010effects models depending on heterogeneity. Effect estimates were reported as risk ratios (RRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies comprising a total of 8986 KTRs (3962 with MS and 5024 without MS) were included. Six studies reported major adverse cardiovascular events and all\u2010cause mortality, nine studies reported graft failure, and seven studies reported acute graft rejection. KTRs with MS had higher risk for major adverse cardiovascular events (RR 2.12, 95% CI: 1.32 to 3.41,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002), all\u2010cause mortality (RR 1.78, 95% CI: 1.21 to 2.62,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), graft failure (RR 1.95, 95% CI 1.58 to 2.39,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.00001) and acute graft rejection (RR 1.53, 95% CI 1.11 to 2.11,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>KTRs with MS are at significantly increased risk of adverse cardiovascular and renal outcomes. Further large\u2010scale prospective cohort studies using standardized definitions are needed to strengthen causal inference and guide clinical management in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70519","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:03:07Z","timestamp":1774969387000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cardiovascular and Renal Outcomes Among Kidney Transplant Recipients With Metabolic Syndrome: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3720-9075","authenticated-orcid":false,"given":"Min Yie","family":"Lim","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Malaya  Kuala Lumpur 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