Objectives: To evaluate the clinical significance of sclerostin for cardiovascular and bone mineral outcomes in kidney transplantation (KT) patients. Methods: From prospective observational study of the Korean Cohort Study for Outcome in Patients with Kidney Transplantation (KNOW-KT), a total of 850 patients who measured serum sclerostin at three years after KT were analysed. The main predictors were sclerostin levels at three years after KT. The cardiovascular outcomes were brachial-ankle pulse wave velocity (PWV; at five years after KT; n=532), coronary calcium score (CCS; at five years after KT; n=687) and intervention-requiring cardiovascular event that occurred from three years after KT. The bone mineral outcomes were hip bone mineral density (BMD; at five years after KT; n=630) and fracture that occurred from three years after KT. Results: At baseline, patient groups with higher sclerostin levels were more often associated with old age, male sex, hypertension, diabetes, higher body mass index, lower 1,25-OH2 Vit-D level, and more beta-blocker use. Increased sclerostin levels was associated with increased PWV levels after adjusting for covariates (coefficient, 102.6; 95% CI, 10.1-195.1), whereas increased sclerostin levels was not associated with CCS. During 3618.7 person-years of follow-up (median 4.3 years), the cardiovascular events occurred in 16 patients (1.9%). Cox regression analysis revealed that the hazard ratio for cardiovascular event increased with increasing sclerostin level but non-significant (HR, 3.96; 95% CI, 0.90-17.50). Next, increased sclerostin levels was associated with increased femur BMD level after adjusting for covariates (coefficient, 0.42; 95% CI, 0.15-0.69). Fracture events occurred in 23 patients (2.7%) and was not associated with sclerostin level (HR, 1.00; 95% CI, 0.91-1.10). Conclusions: Sclerostin level was associated with increased arterial stiffness; however, its association with cardiovascular event was inconclusive in KT patients. Positive association of sclerostin level with hip bone density may reflect amount of bone mass.