be female (37% vs. 23%, p = 0.05), and were transplanted more recently (median years since transplant 5.1 vs. In the first question, patients were asked: “How has your life changed since having a kidney transplant?” Six themes were identified from the 414 responses. Themes included improved quality of life and return to normalcy (n = 197); better health and more energy (n = 69); gratitude and sense of purpose or freedom (n = 55); burdens of post-transplant regimens (n = 37); no change (n = 30); and worsened and less energy (n = 23). These themes are reported in Table 2, and examples of responses are provided in Table 3. Thirty-nine patients wrote “yes” without further qualification. As it was unclear whether those changes were positive or negative, those 39 responses were not further analyzed.The most common change noted after a kidney transplant was an improvement in quality of life and a return to normalcy. For many, no longer attending dialysis clinic multiple days per week allowed them to, as one patient wrote, “have a daily schedule” and as another patient wrote, have a “routine daily life.” Some reported that they have the time post-transplant to work, spend time with their families, and conduct tasks of daily living. Many patients also could use this time in new ways because they felt better, describing it as “I now have a life. I can participate in activities that I couldn’t before.” This led to a strong sense of normalcy for some; e.g., “I am able to feel human and alive again” which may in turn have caused the stress of their pre-transplant lives to fade. As one patient wrote: “happy to not be hooked up to dialysis anymore almost to a point I forget I ever was.”The enthusiasm expressed in the survey responses varied, but many conveyed strong emotion. This was expressed in intense punctuation, “No more dialysis!! Wonderful!!” and phrases written in all capital letters: “I CAN SEE RETIREMENT!!” Even in more muted responses, e.g., “It has been much better. I am happy I got it”, the change was evident. In writing about the extremes of pre-transplant life, some patients may have used hyperbole to show a dramatic contrast with their post-transplant lives, e.g., “not doing dialysis 10 hours per day.”Many patients reported improvements in their health. Some of these responses were particularly strong; e.g., “I feel awesome!!” and “having health restored is an incredible experience.” However, some of the subdued responses also affirmed the substantial improvement that can occur after a transplant; e.g., “overall better health” and “I feel better all over.” One patient reported “not sick daily,” and another wrote “feel well the majority of the time.” Many also commented on increased energy.Recipients discussed the relief they felt from the burdens of renal failure and dialysis. One patient wrote “enjoy even the small things, feel blessed,” and another reported “every single day is a gift.” Many participants specifically mentioned feeling an increased sense of freedom, e.g., “feel better and free.” This was often presented in the context of no longer having regular dialysis visits, e.g., “able to travel without the formality of finding a clinic to dialyze in while out of state” and “no sense of doom.” Another patient reported that “it [the transplant] has been the most wonderful gift I have ever gotten. It has given me back my freedom to travel.” Some mentioned a new sense of conviction. One felt “more purposeful,” and another reported, “it [their life] has become full of more purpose. I feel I have been given a 2nd chance.” A recipient reported “being in control of my destiny.” Patients also noted a greater sense of hopefulness; one reported “optimism,” another commented “more positive,” and a third wrote they are “thankful for each day, life is short.”Patients also reported undesirable changes to their lives after transplantation. Often these were related to medications. Recipients take medications at least twice daily to prevent rejection and to treat comorbidities. Some patients were matter-of-fact, e.g., “lots of meds” and “just taking more pills.” Others alluded to the burden of the required medication; e.g., “it’s a hassle to take meds every 12 hours” and “continuously taking meds.” For some, changes in medication defined their post-transplant experience. A recipient wrote that “The only change has been the medication regimen. Over the term to date of my transplant I have taken more than 85,000 pills.” Others mentioned the dietary restrictions that can be added after a transplant, including as one wrote “not eating what I want.”Some patients reported that they did not experience substantial changes after receiving a transplant. Many of these responses were simply “no.” Another recipient wrote “it has not changed,” and others reported “very little” or “not much.”Finally, some patients reported having less energy, describing it as “no pep” and “have slowed down… sometimes just don’t care.” They also reported instances of poor transplant outcomes, many of which were related to comorbidities. One patient wrote “radical changes” and that he or she is “unable to work due to secondary problems from ESRD & Diabetes.” Another reported “other conditions worse.”Concerns about their healthcare and future quality of lifeThe second open-ended question asked: “What concerns you most about your health care and future quality of life?” Three