Introduction: The quality of ambulatory transplant care of renal transplant recipients after discharge from their tertiary transplant centre is unclear. However, in Singapore, all renal transplant recipients remain on follow-up at the tertiary transplant centre which provides a unique opportunity to examine the quality of ambulatory transplant care among non-transplant nephrologists.
Methods: This was a prospective study of 703 out of 797 transplant recipients who performed their annual health screening tests where transplant coordinators collected data on renal function, 24-hour urinary creatinine clearance and protein excretion, hemoglobin, lipid profile. albumin and mineral bone status. Descriptive statistics were used to analyze the data.
Results: The median age of the study population was 58 +/- 10.7 years with 22.9% (n=161/703) aged 65 years and older. As our renal transplant program started in 1970, 26.0% (n=183/703) had functioning kidney transplants for 20 years or more. Male and Chinese race comprised of 59.9% (n=421/703) and 94.5% (n=664/703) of patients. Local deceased and living kidney donor transplants comprised 26.0% (n=183/703) and 55.6% (n=391/703) while non-local transplants comprised 31.7% (n=223/703). Only 38.2% (n=283/703) of patients had eGFR 60 ml/min or more but 11.0% (n=77/703) had 24-hour urinary protein levels of 1g/d or more.  Suboptimal systolic (> 130 mmHg) and diastolic (> 80 mmHg) blood pressure was measured in 60.0% (n=421/703) and 16.8% (n=118/703) of the population. With respect to metabolic profile, 12.1% (n=85/703) of diabetics had HbAic of 7 or more while lipid control was suboptimal in the majority with 51.1% (n=359/703) having serum LDL more than 2.59 mmol/L.  Obesity as defined by BMI more than 30 kg/m2 was seen in 12.1% (n=85/703) while hyperuricemia was common in 63.7% (n=448/703). Hypercalcemia (Ca > 2.6 mmol/L) and elevation of PTH (> 6.2 pmol/L) was seen in 7.3% (n=51/703) and 61.5% (n=432/703) respectively. 
Conclusion: This study provides insight into the quality of ambulatory transplant care in a prevalent population of renal transplant recipients, showing that blood pressure and metabolic parameters can be better managed in the outpatient clinic. Majority of patients also had suboptimal allograft function which raises the importance of continuation of good chronic kidney disease care after transplantation.