Renal transplantation is the only effective treatment in end-stage renal disease, which provided better well-being but at the same time triggers numerous psychological implications [20,21,22]. There is variation in the quality of life, coping, and psychiatric morbidity among renal transplant recipients .
QoL refers to the social, physical, and psychological domains of health, which influenced by the patient’s perception of the culture and value system , and in relation to his goals and expectation .
Thus, evaluation of the QoL in PRTRs has been considered as an important way to determine the impact of transplantation operation on those patients .
This study was dedicated to exploring the quality of life and its correlates among Egyptian renal transplant recipients. The study revealed that PRTRs had unsatisfactory social QoL, and the majority had unsatisfactory overall, independence, environmental, physical, and psychological aspects of QoL. We are in contrast with previous investigators who reported better QoL after the operation in Bangladesh and India [12, 25]. In another community , a study also reported improvement of QoL in all of his patients by using a multidimensional QoL scale (WHOQL Brief).
Our finding was in congruence with another study by Beard  who reported that QoL is seriously affected by transplant operation, and another study by Johnson et al.  also highlighted that African American PRTRs achieve less improvement in QoL than Caucasian Americans.
The life after kidney transplantation is a life with uncertainty . There is unrealistic expectation which lowered the perception of the transplant receipts of their quality of life and made them less satisfied with the outcome. Moreover, the transplant recipients have to cope with fear of death, fear from graft's rejection, and fear from non-return to work. Thus, they suffer from damage to their self-esteem in that their relationships with significant people are reduced to hostile and/or dependent attachments .
Another factor contributed to the poor quality of life is the need of receiving immunosuppressive medication with adverse side effects .
Long-term QoL in recipients depends on many factors include the subject’s age, education received, marital condition, living situation, and employment .
In our study, age was negatively correlated with QoL, the younger age group had unsatisfactory QoL in all domains except the spiritual one. They had more worry regarding the future graft, their life is never anxiety-free, and their continuous concern about body functions triggers an intense fear which impacts their QoL [22, 30].
There is variation in the relation between age and QoL in the PRTRs, while Shah et al. 2006  have reported that QoL in PRTRs was not correlated with age, and other study in Thai society found that the older recipients had unsatisfactory QoL due to their inability to carry out various activities . The differences in this data may be related to the trans-cultural differences or the tools used.
It was found that gender was not related to QoL. Our findings yielded support to previous data reported by several researches [20, 32,33,34]. It is contrary to that of Johnson who reported poor QoL among men .
There was no relationship between QoL and marital status. This may reflect that care giving in Egyptian families may be carried out via the extended families. The same findings were found in Indian community .
Level of education
We found positive correlation of satisfactory QoL with the years of education received. This may be due to the impact of learning on development of coping strategies.
Tennen and Affleck  stated that low education and the perception of medical care as being a substantial economic burden predict poor coping and independence and poorer functional status; moreover, Eryilmaz et al.  found that lower education is considered as negatively effective factor on the QoL of PRTRs.
The unsatisfactory QoL was found more among the unemployed and unskilled laborers with significant correlation with independence and environmental domains of QoL.
Despite that different publications [4, 30] have proved that medical comorbidity, side effects of immune suppressant drugs, duration of hemodialysis prior to the operation or time elapsed since the surgery, and type of donors may affect the recipients QoL, yet we did not find such relation in our PRTRs. The difference may be related to different sample or tools used.
In concordance with previous study, we proved that physical QoL was correlated significantly with age . The psychological and independence QoL were correlated with age, sex, education level, and occupation. These findings may point that those patients may feel less positive about themselves.