OBJECTIVES : There are limited data about the role of clinical Pharmacist as a direct care provider for renal transplant recipients, especially in the Arab world. This study aims at describing a single center experience in providing clinical pharmacy services for recently kidney transplanted patients.

METHODS : A pilot descriptive study has been conducted from January 2019 till April 2019 in the renal transplant unit of the Armed forces hospitals southern region, Saudi Arabia. A clinical Pharmacist attended the renal transplant selection committee weekly meetings, attended daily rounds, provided necessary drug therapy recommendations, responded to drug information requests, conducted medication reconciliation upon patients' admission and discharge and provided verbal and written pre and post-transplant patient education (during admission, post-transplant clinics visits and through social media)

RESULTS : During the study period, 21 patients transplanted in the unit (52.4% females, mean age = 40.5 years SD=17.35 years). The clinical Pharmacist had 141 recommendations (6.7 recommendations per patient). Sixty-two recommendations (44%) were medication reconciliation related, 11 recommendations (7.8%) based on drug information requests while the remaining 48.2% were pharmacotherapeutic recommendations provided during daily rounds. Clinical pharmacist's recommendations involved immunosuppressive agents (34.8%), Antimicrobials (13.8%), bone-mineral disorders medications (11.5%), Electrolytes (9.4%), Anemia management medications (8.6%), Anticoagulants (4.3%), Antihypertensives (3.6%), antidiabetics (2.9%) and Miscellaneous medications (11.1%). The recommendations involved medications doses increases (38.2%),medications added (25%), doses reductions (16.2%), therapeutic drug monitoring lab requests (11.8%), medication discontinuation (5.9%) and medication substitution (2.9%). The overall physicians' acceptance rate of clinical Pharmacist's recommendations was 95.6%.

CONCLUSIONS : The study findings suggest that clinical pharmacists could positively impact the quality of care for renal transplant recipients and promote their medication safety.