*Purpose: Our center actively follows kidney transplant recipients (KTRs) from across the USA and many other countries for the life of the allograft with recommended annual clinical assessments and measurement of kidney function and immunosuppression levels assessed with mailed lab kits every 3-6 months. An unknown number of patients are non-adherent to this protocol for unclear reasons. This burdens nurse coordinators and ancillary staff that make multiple attempts to contact these patients for follow-up as well as added costs of unused kits. Given these concerns, we initiated a QI project to assess the burden of loss to follow-up (LTF) at our facility in order to identify and contact this patient population.

*Methods: We assembled a multidisciplinary team comprising transplant nephrologists, quality administration, nurse coordinators, medical secretaries, a pharmacist and a statistician. The group developed a protocol (Figure 1) to identify and contact kidney transplant recipients actively followed with functioning allografts. We defined LTF as no patient contact including no upcoming appointment, no prescription refills obtained, and no creatinine level assessment for > 1 year. Those with failed allografts followed for immunosuppression management only were excluded.

*Results: After protocol initiation, 2596 actively followed KTRs transplanted between 1966-2019. An obituary search identified 6 deceased over the past year. After medical record review, 126 patients met inclusion criteria above. After patients were contacted over the phone and sent standardized letters, we were notified of 3 recipient deaths by family members, 3 reported transfer of care, 8 agreed to follow-up, and 112 remained LTF (112/2596 or 4.3%). Reported contributors to LTF were distance to transplant center (including 15% of patients were from other countries), financial constraints, and lack of social support.

*Conclusions: We have demonstrated the feasibility and utility of a protocol to identify and contact KTRs that are LTF. This protocol has reduced the workload of nurses and ancillary staff work, reduced costs, and has led to future projects in improving long-term follow-up and adherence. Queries will continue to occur quarterly to identify KTRs that are LTF.

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