AbstractBackgroundPost‐transplant health‐related quality of life (HRQOL) is associated with health outcomes for kidney transplant (KT) recipients. However, pretransplant predictors of improvements in post‐transplant HRQOL remain incompletely understood. Namely, important pretransplant cultural factors, such as experience of discrimination, perceived racism in healthcare, or mistrust of the healthcare system, have not been examined as potential HRQOL predictors. Also, few have examined predictors of decline in HRQOL post‐transplant.MethodsUsing data from a prospective cohort study, we examined HRQOL change pre‐ to post‐transplant, and novel cultural predictors of the change. We measured physical, mental, and kidney‐specific HRQOL as outcomes, and used cultural factors as predictors, controlling for demographic, clinical, psychosocial, and transplant knowledge covariates.ResultsAmong 166 KT recipients (57% male; mean age 50.6 years; 61.4% > high school graduates; 80% non‐Hispanic White), we found mental and physical, but not kidney‐specific, HRQOL significantly improved post‐transplant. No culturally related factors outside of medical mistrust significantly predicted change in any HRQOL outcome. Instead, demographic, knowledge, and clinical factors significantly predicted decline in each HRQOL domain: physical HRQOL—older age, more post‐KT complications, higher pre‐KT physical HRQOL; mental HRQOL—having less information pre‐KT, greater pre‐KT mental HRQOL; and, kidney‐specific HRQOL—poorer kidney functioning post‐KT, lower expectations for physical condition to improve, and higher pre‐KT kidney‐specific HRQOL.ConclusionsInstead of cultural factors, predictors of HRQOL decline included demographic, knowledge, and clinical factors. These findings are useful for identifying patient groups that may be at greater risk of poorer post‐transplant outcomes, in order to target individualized support to patients.