*Purpose: Cardiovascular events and reduced graft survival due to non-adherence are the most important reasons for morbidity and mortality after KTx. Outpatient care in Germany is split between transplant centers and nephrology practices which is often not perfectly coordinated and uses 20^th century rather than digital communication.

*Methods: The new aftercare program for pediatric and adult KTx patients was implemented comprising a central coordination of patient visits, case-management, electronic case files, telemedicine, risk-assessment based interventions for non-adherence by psychosomatic counselling and of cardiovascular risks by individualized physical training. The study used a quasi-experimental design with two data sources: primary data collected among study participants and secondary data, i. e., claims data from health insurance companies. In primary data longitudinal changes were studied. In claims data changes from a control period (before 2017) to the intervention period (after 2017) were compared between the ITT-group (intervention centers) and the control group (other centers).

*Results: 937 adult (mean age 52±14 years, 41% f, 28% LD) and 72 pediatric patients (mean age 11±45 years, 46% f, 30% LD) were included in 3 German centers. The external control cohort consisted of 2565, the internal and external historic control cohorts of 269 and 3028 patients. Graft loss was significantly lower in the intervention group as compared to the external cohort (6% vs. 9%, p=0.08). In adults, adherence to aftercare visits was significantly higher in the intervention group as compared to external controls (93% vs. 56%, p<0.001). Adherence to immunosuppressants increased significantly over time (b=0.06, p=0.006), Hospitalization due to cardiovascular events was significantly lower in the KTx360° patients compared to the external cohort (7 vs. 17%, p<0.001). The case management was used by 99% of the patients. General SOPs were developed and implemented. A reduction of hospitalizations and health care costs could not yet be reached during the study period.

*Conclusions: The multimodal and multidisciplinary KTx360°-program significantly improved the clinical course after KTx. Main achievements were improved graft survival, increase of adherence, and reduction of cardiovascular risks. It can be speculated that these effects will also lead to an improvement in long-term patient and graft survival. A health care cost reduction could not be shown during the study period; however, longer-term follow-up is warranted to better investigate the effect on care costs.

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