The qualitative study was carried out as a part of a larger longitudinal study on renal transplant recipients (RTRs) following a successful transplant in Pakistan. The aim was to explore why recipients with similar physical health status and healthy kidney functioning, differ in perceptions of Quality of life. Using in depth interviews the study participants with the highest and lowest scores on a standardized QoL index were asked to describe their experiences and attributions regarding kidney failure and to describe their health status pre-and post-transplant. The themes emerging from the analysis related to individual differences in the ‘impact’ of transplant on ‘relationships’ with significant others, (family, work and social life) ‘self identity’, ‘social comparisons’, perceptions of... ‘health care and medical professionals’, adjustment, acceptance and ‘coping’ with a transplant. The recipients with a positive perception in these aspects tend to report a more satisfied QoL.