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De novo thrombotic microangiopathy (TMA) is a rare and challenging condition in kidney transplant recipients, with limited research on its incidence and impact on graft survival. This study conducted a systematic review and meta-analysis of 28 cohorts/single-arm studies and 46 case series/reports from database inception to June 2022. In meta-analysis, among 14,410 kidney allograft recipients, de novo TMA occurred in 3.20% [95% confidence interval (CI): 1.93–4.77], with systemic and renal-limited TMA rates of 1.38% (95% CI: 06.5–2.39) and 2.80% (95% CI: 1.27–4.91), respectively. The overall graft loss rate of de novo TMA was 33.79% (95% CI: 26.14–41.88) in meta-analysis. This study provides valuable insights into the incidence and graft outcomes of de novo TMA in kidney transplant recipients.