Introduction: Worldwide, the number of patients with chronic kidney disease is steadily increasing result of the aging population. Especially, South Korea is becoming the most rapidly aging society in the world. Nowadays, age is not an absolute contraindication to kidney transplantation caused by the improved surgical techniques and the developed immunosuppressants related to kidney transplantation. For this reason, there is an increase in elderly patients receiving kidney transplants globally including in Korea. However, they are who elderly kidney transplantation recipients still have many risk factors basically according to age. In other words, elderly kidney transplant recipients may be facing many challenges and susceptible circumstances. As a result, elderly recipients may experience an adaptation process after kidney transplantation different from other adult kidney transplant recipients.

Methods: This study aimed to explore the process of adaptation after kidney transplantation in elderly recipients. A qualitative descriptive design was used based on the grounded theory methodology developed by Strauss and Corbin. Data were collected through individual in-depth interviews with individual participants. Qualitative data from transcribed notes and field notes were analyzed using constants comparative method with theoretical saturation.

Results: A total of 16 elderly kidney transplantation ( ≥ 60 years) were recruited at a university hospital in South Korea. The core category of adaptation process after kidney transplantation in elderly recipients was ‘A journey of straining to save the last lifeline’. The adaptation process consisted of three stages ‘Confusing stage’, ‘Depressed stage’, and ‘Compromising stage’. Causal condition was ‘Unexpected reality with multiple restriction’ and contextual conditions were ‘Support system’ and ‘Medical resources’. The action/interaction strategies were ‘Practicing self-management’, ‘Appreciating and expecting’, ‘Holding will to live’, and ‘Accepting reality’. The consequences were ‘Acclimatization’ and ‘Withdrawal’.

Conclusion: Although the number of kidney transplantation in the elderly is increasing associated with a many advantages of quality of life, survibal, they experience some of difficulties after transplantation and face an unexpected crisis. That is, the experience and adaptation process after kidney transplantation in elderly recipients is different from those of other adult kidney recipients. Therefore, tailored interventions based on an in-depth understanding of the adaptation process found in this study are needed to improve adaptation after kidney transplantation in elderly recipients. In particular, feasible and realistic education and counseling are required for each adaptation phase, considering that adaptation occurs in a long period adaptation after transplantation.