results of transplant,” and another reported “there is often no concern at the hospital… about my poor immune system and right dosage of my medication (and not listening to my correction and causing invalid blood count).”This analysis provides a broad view of the patient experience following kidney transplantation. Questions prompted recipients to consider how their lives had changed and their concerns about their healthcare and quality of life. Many themes emerged from the responses, including experiencing higher quality of life and better health since transplantation as well as concerns about future health, costs, and burdens of care. These themes echo and extend results from studies of kidney transplant recipients in other contexts Our results suggest that patients have disparate experiences post-transplant. When asked “How has your life changed since having a kidney transplant?”, the largest portion of patients reported improvements in quality of life and health, while several reported that there had been no change, and some said their lives had worsened. This is consistent with Orr et al. ([4] citing Orr A: “Patient attitudes to renal transplantation and quality of life following renal transplantation: an exploratory study,” unpublished)— who found that 15% of transplant patients experienced difficulties—and other studies that have reported improvements [3, 24]. Similarly, prior studies have reported different results for changes in energy level; some have seen increases [3, 8], and others have reported decreases [5, 11, 23]. Patient responses in this study lend credence to the finding that energy levels after kidney transplantation vary between recipients. Similarly, participants reported a variety of common comorbidities including diabetes, cancer, and heart disease [6], though these do not affect all patients.In addition, while many patients expressed the desire for a normal life, patients may have different views on what a “normal life” is. Some recipients mentioned that they have returned to work. Others reported that they were better able to care for themselves and others, travel, and spend time with their families. While providers may consider returning to work an important metric for transplant success [23, 25,26,27], the range of responses indicate that patients may define normalcy more broadly [5].The effects of a kidney transplant are not limited to a patient’s physical health or lifestyle; it can also have substantial psychological benefits. Patients expressed feeling a heightened sense of purpose and gratitude to be alive. For many, this manifested itself in an increased sense of freedom. While Smith et al. did not find statistically significant differences in the amount patients traveled pre- vs. post-transplant [8], recipients can travel without having to make cumbersome dialysis arrangements to maintain their dialysis regimes while away from their customary dialysis facilities. The optimism may also be derived from how much better many patients feel. As their health improves, it is perhaps natural to foresee the trajectory of their lives improving as well.However, some patients also expressed a psychological weight from changes post-transplant. A large portion reported concerns regarding the potential for graft failure. Past studies that have asked patients to rank possible transplant outcomes found that patients considered graft failure worse than death [6, 10] and that the risk of graft loss is a persistent fear [5]. Our study adds to past literature in that it expands on why graft failure is concerning. Patients reported stress related to the uncertainty about when the failure would occur and the implications for life afterwards. The anxiety about returning to dialysis may be due to both the physical toll and the potential burden on their support systems. Furthermore, some patients expressed an obligation to live a life of purpose because of the gift of the transplant; this echoes a prior study that reported some patients felt a duty to care for their kidney [4].We see a resonance in many of the patient perspectives with other studies conducted with patients outside of the US This lends support to the sense that the themes of quality of life and health post-transplant and views on graft failure and living a life of purpose may be experienced broadly.In contrast, other prominent concerns included cost and insurance, which may be more important within the US context. These were among the strongest responses, perhaps because they threaten both quality of life and health. In particular, some of these concerns may relate to the US payment system for immunosuppressant medications. After a kidney transplant, Medicare pays for the immunosuppressant medications for the first 3 years but not after that time (unless the patient qualifies for Medicare via age or disability). Medications that are not covered by insurance can cost thousands of dollars out of pocket annually [28, 29]. Patients also expressed specific concerns about insurance. This may affect how patients evaluate the decision to return to work; e.g., patients may be unlikely to work part-time if it would lead to a loss of government benefits. In the time since the survey was conducted (2015), public policy in the US regarding healthcare