Background <p>Kidney transplantation greatly improves survival and quality of life for children and adolescents with kidney failure. However, it also brings psychological and social challenges, including anxiety, depression, and difficulties with adaptation. Families often face ongoing stress even after successful transplantation. Although qualitative studies have explored these issues, no systematic review has synthesized their findings. This study aims to fill that gap by reviewing qualitative research on the post-transplant experiences of children and adolescents, providing insights to support their psychosocial well-being.</p> Design <p>This was a systematic review of qualitative studies.</p> Data sources <p>Literature searches were conducted in PubMed, Web of Science, CINAHL, Embase, Scopus, ProQuest, China National Knowledge Infrastructure (CNKI), and Wanfang database. The search period was from the inception of the databases up to January 2025.</p> Review methods <p>This review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis for qualitative research. Two reviewers independently carried out the screening process and data extraction. Studies meeting the inclusion criteria were evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative studies. Thematic synthesis was performed following the approach outlined by Thomas and Harden.</p> Results <p>A total of ten descriptive themes were extracted from the included qualitative studies. Through a process of thematic synthesis, these were consolidated into three overarching analytical themes: (1) Rebirth and Transformation — capturing the personal growth, psychological adaptation, and evolving identity experienced by children and adolescents following kidney transplantation; (2) Facing Challenges — reflecting the physical, emotional, and social difficulties encountered during recovery and reintegration into daily life; and (3) Future Uncertainty and Lack of Support — highlighting ongoing concerns related to long-term health outcomes, fear of graft failure, and the perceived inadequacy of informational, and systemic support.</p> Conclusion <p>Kidney transplantation offers children and adolescents a renewed chance at life, boosting their self-esteem and overall well-being. However, they often face considerable psychological stress, including anxiety about the future and limited support. To address these challenges, healthcare providers and social organizations must focus on their unique needs through comprehensive psychological assessments, identification of unmet needs, and strengthened collaboration among medical teams, families, and communities.</p> <p><b>Trial registration</b>: PROSPERO: (CRD420250654624).</p> Graphical Abstract <p>A higher resolution version of the Graphical abstract is available as Supplementary information.</p> <p></p>