Background: To many individuals with end-stage renal disease, kidney transplantation is the best option. Proteinuria and a lower glomerular filtration rate have been linked to metabolic syndrome, implying a connection to chronic kidney disease. Aim: To evaluate the impact of metabolic syndrome on kidney transplantation outcome. Subjects and methods: This cohort study was conducted on 230 kidney transplant recipients in Urology and Nephrology Center, Mansoura University. We classified the included recipients into two groups with or without metabolic syndrome. Records of all kidney recipients were reviewed for pre-operative details, operative details in addition to post-operative details. In each visit, recipients were subjected to full history taking, thorough clinical examination and routine laboratory investigations. Radiological investigations were done as abdominal ultrasound (when indicated) in addition to graft grey scale ultrasound and doppler ultrasound if there is clinical suspicion of acute rejection, acute tubular necrosis, or renal artery thrombosis. Histopathological examination of the graft biopsy in cases of graft dysfunction was carried out. Results: Both groups were comparable regarding baseline data. Pre-transplant hypertension incidence was higher among the study groups. Tacrolimus was avoided in the study group. Incidence of rejection and other post-transplant medical complications was higher among the study group Conclusion: Metabolic syndrome has a negative impact on kidney transplantation outcome. Metabolic syndrome is associated with higher incidence of acute rejection and acute tubular necrosis. .