improvements in recipient care and sense of well-being.Methods We conducted a paper-based survey from March 23 to October 1, 2015 of 476 kidney transplant recipients at the University of Michigan Health System in Ann Arbor, Michigan. We analyzed their open-ended responses using qualitative research methods. This is a companion analysis to a previous quantitative report on the closed-ended responses to that survey.Common themes relating to changes following transplantation included: improvements in quality of life, a return to normalcy, better health and more energy. Concerns included: duration of graft survival, fears about one day returning to dialysis or needing to undergo another kidney transplant, comorbidities, future quality of life, and the cost and quality of their healthcare. Many recipients were grateful for their transplant, but some were anxious about the burdens transplantation placed on their loved ones.While most recipients reported meaningful improvements in health and lifestyle after kidney transplantation, a minority of participants experienced declines in energy or health status. Worries about how long the transplant will function, future health, and cost and quality of healthcare are prevalent. Future research could study the effects of providing additional information, programs, and interventions following transplantation that target these concerns. This may better prepare and support kidney recipients and lead to improvements in the patient experience. Kidney transplantation has transformed the care of patients with end-stage renal disease (ESRD). Each year, approximately 17,600 kidney transplants are performed within the United States (US), and currently 193,000 patients live with a functioning graft [1]. If the transplant functions for at least 1 year, the median survival of the kidney, depending on the donor type, is between 12 and 16 years [2]. Transplants can provide dramatic improvements in quality of life and health status [3]. However, improved outcomes are not universal [4], and most patients are expected to eventually suffer graft loss [2].Despite the large and growing population of kidney transplant recipients, there is a limited understanding of the subjective patient experience following transplantation. A handful of qualitative studies have reported recipient perspectives. These include Boaz and Morgan, who interviewed kidney transplant recipients to study the return to normalcy, and Orr et al. who used focus groups to understand quality of life [4, 5]. They found that recipients define a normal life in a variety of ways and reported common themes of fear, gratitude, and a medicalization of their lives. While these teams spoke with 26 and 25 patients respectively, a wider sample may be better able to capture nuances of the post-transplant experience. Howell et al. used focus-nominal groups to study trade-offs between outcomes associated with immunosuppression [6]. They found that patients would rather experience severe treatment-related adverse events than lose their grafts, thereby illuminating the importance of understanding and including the patient perspective in clinical decision-making. Other studies in this area have used closed-ended questions to study patient experiences. Some compared life before and after transplant [7,8,9] and found that prior to transplant patients may overestimate gains in quality-of-life. One of the few studies that included prompts about the future was a follow-up of the Howell et al. qualitative analysis; they asked patients to rank post-transplant outcomes and found, supporting results from their earlier studies, that patients ranked graft loss worse than death [6, 10]. While there are reports on recipient perspectives from around the world (e.g., Europe [4, 5, 7]; Australia [6, 10]; Asia [11]; and Middle East [12]), there is little data on experiences and future expectations of recipients within the US. Experiences and interactions with healthcare systems may be strongly affected by the context of care, especially as it relates to cost and support systems.This report is part of a larger study that seeks to understand the perspectives of kidney transplant recipients and their healthcare providers post-transplant. An earlier paper compared patient and provider responses to closed-ended survey questions from the same sample used in this analysis [13]. The objective of the current paper is to draw themes from open-ended responses about life changes, concerns about healthcare and future quality of life, and other reported post-transplant experiences.This study was approved by the University of Michigan (UM) Institutional Review Board (HUM00079279). The survey instrument was designed based on two initial focus groups (one with patients and one with providers). Each had five participants. Both groups lasted 1 h and included discussions about the post-transplant goals and expectations of kidney recipients. An experienced qualitative researcher (SJG) facilitated these sessions. After the survey was drafted, it was validated through two cognitive interview sessions to determine whether the participants understood the content of the questions. One session included three patient participants and the other