Adherence to immunosuppressive therapy after kidney transplantation is crucial to avoid graft rejection and optimise long term patient and graft survival. However, patient's adherence is not always optimal. Our aim was to identify reasons for non-adherence and health-related quality of life (HRQoL) dimensions affected by immunosuppressant therapy (IT) after kidney transplantation (KT) including patient preference of once daily over twice daily immunosuppressive regimen. MethOds: A literature review on adherence to immunosuppressant therapy (IT) and impact of IT on HRQoL through the EMBASE database was performed. Interviews were conducted with 2 clinical experts to determine key concepts related to KT and immunosuppressants. Thirty-six patients in four focus groups were asked to cite important concepts related to adherence and impact of IT on HRQoL and rate them. Qualitative analysis was conducted to code patient's responses. Results: The results showed that non-adherence was mostly unintentional among the participants. The reason for non-adherence included forgetfulness, interference with lifestyle, being asleep at the time the medication should be taken, change in routine and impact of side effects. The twice daily regimen was more problematic in relation to adherence. Overall, participants were of the opinion that a once daily IT regimen would help them be more adherent. Also, IT impacts on the HRQoL of the patient in a number of ways including: restricting the patients' lifestyle, causing anxiety or impairing the patient's ability to work. Although the patients happily oblige to the necessity of taking IT medication, patients preferred to reduce the burden associated with medication. cOnclusiOns: This study suggested that patients strongly valued adherence to IT medication and saw a change in the regimen from twice daily to once daily as one way to improve their adherence to IT. Results also suggested that a once daily regimen could improve patient's HRQoL.