To investigate the incidence and risk factors of metabolic syndrome (MS) one year after renal transplantation.

The clinical data of 552 kidney transplant recipients in the Kidney Transplant Center of the First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2020 were retrospectively analyzed. According to whether or not MS occurs, it is divided into MS group and non-MS group. Single factor and multiple factor Logistic regression analysis were used to analyze the risk factors of MS occurrence, and the risk prediction model was constructed and the effectiveness was verified.

Among 552 renal transplant recipients without diabetes before operation, 81 cases (14.67%) developed MS one year after operation. Multivariate analysis showed that preoperative hypertension history (OR=18.392, 95%CI: 3.938-85.909), BMI (OR=1.153, 95%CI: 1.029-1.292), and postoperative sirolimus (OR=2.618, 95%CI: 1.030-7.450), systolic blood pressure (OR=1.033, 95%CI: 1.007-1.060), fasting blood glucose (OR=9.524, 95%CI: 5.727-15.840) and triglyceride levels (OR=3.709, 95%CI: 2.395-5.745) were independent risk factors for MS one year after renal transplantation (all P < 0.05). The risk prediction model was constructed as follows: ln(p/1-p)=2.912×preoperative hypertension history+ 0.142×BMI (kg/m²) + 0.962×postoperative sirolimus+ 0.033×postoperative systolic blood pressure (mmHg)+ 2.254×postoperative fasting blood glucose (mmol/L)+ 1.311×postoperative triglyceride (mmol/L)-28.013. The area under the receiver operating characteristic curve is 0.946, the optimal cutoff value is 0.183, the sensitivity is 0.889, the specificity is 0.890. The prediction curve of the model fitted well with the ideal curve and had good prediction ability.

The occurrence of MS one year after renal transplantation is closely related to the recipient′s history of hypertension, preoperative BMI, postoperative sirolimus, postoperative systolic blood pressure, fasting blood glucose and triglyceride levels. Medical staff can use the risk prediction model to conduct risk screening for kidney transplant recipients, strictly control BMI before surgery, formulate personalized immunosuppressive programs after surgery, closely monitor relevant indicators, timely screen and identify high-risk groups of MS, and implement targeted and precise interventions to reduce the occurrence of MS after kidney transplantation.