Background: With Food and Drug Administration (FDA) approval of clinical trials of kidney xenotransplantation (XTx) in living humans, understanding the patient experience is critical for defining success beyond graft and patient survival. We explored patient perspectives by interviewing the two longest-living kidney xenograft recipients.
Methods: We conducted semi-structured interviews on patient-defined success, quality of life (QOL), fears about XTx, and healthcare team communication and support. Interviews were recorded, transcribed, and analyzed by two qualitative researchers using an inductive thematic approach. 
Results: Both recipients (53-year-old female; 66-year-old male) described a restoration of hope and return to normal life, contrasting with desperation pre-transplant due to sensitization and waning participation in daily life activities. Both recipients found purpose in supporting the broader kidney disease and transplant community and took comfort in their faith. They emphasized that access to transplantation and graft survival requires mutual confidence and commitment between recipients and healthcare teams, as well as trust despite fear and family concerns. To contextualize findings, we mapped themes onto the Wilson and Cleary model for health-related QOL, a validated framework integrating biological, social, and psychological determinants of patient-reported outcomes.
Conclusions: Reassuringly, these XTx recipients define success and QOL similarly to allotransplant recipients. Their insights provide a framework for guiding patient expectations and informing trial design. Ongoing engagement with current and future recipients will further reinforce the role of XTx in restoring QOL for end-stage patients with limited options.