This study was conducted to explore differentiated aspects of quality of life (QoL) throughout the course of end-stage renal disease (ESRD) with special regard to kidney transplantation (KTX). In detail two questions were addressed: (1) does social support change over time? and (2) is psychological distress a predictor of generic and disease-specific QoL? Two groups of ESRD-patients were investigated twice with different psychodiagnostic inventories. At t0 the Brief Symptom Inventory (BSI) and a validated German Social Support Questionnaire were administered. At t1 social support as well as generic and disease-specific QoL were investigated (SF-36, End-Stage Renal Disease Symptom Checklist-Transplantation Module [ESRD-SCL]). Group A consisted of 80 patients treated by dialysis while on the waiting list for transplantation when investigated at t0 and was followed after successful transplantation at t1. Group B consisted of 222 patients investigated twice after successful KTX. Groups A and B did not differ with respect to clinical data and comorbidity, except for stronger immunosuppression in transplanted patients of group A. Group A demonstrated a statistically significant (5% explanation of variance) increased satisfaction with social support after KTX, whereas group B reported a decrease. The psychological distress at t0 predicted QoL at t1 in both groups (2-13% explanation of variance of SF-36, ESRD-SCL-scores). High psychological distress on dialysis and after KTX is a predictor for low long-term QoL.