Kidney transplant recipients are a growing population in ambulatory care. Medical follow up after the first post transplant year requires a tight collaboration between transplant centers, primary care physicians and community nephrologists. Although kidney transplantation is the treatment of choice for patients in end stage renal failure, no major improvement has been seen in long-term patient and graft survivals. Mortality of kidney transplant recipients remains higher than that of the general population, due to the high incidence of cardiovascular disease, infection and malignancies related to progressive renal failure and also to immunosuppressive treatment. We review here the optimal ambulatory medical care needed by these patients after the first post transplant year.