Background: The care of kidney transplant recipients involves a balance between maximizing graft survival and serious adverse outcomes. This study aimed to quantify patients' preferences and trade-offs for important outcomes after transplantation. Methods: A best-worst scaling survey, analyzed by multinomial-logit models, was used to calculate normalized preference scores (0, best; 1, worst), for varying years of graft duration and risk of dying before graft failure, cancer, cardiovascular disease, diabetes, infection, anxiety/depression, diarrhoea/nausea, and weight gain. Willingness to trade years of graft survival to minimize the risk of adverse outcomes was calculated. Results: Ninety-three transplant recipients from 2 Australian transplant units and an on-line panel (aged 18-69 years (mean time since transplantation, 7 years) completed the survey. Graft loss at 1 year was the least desirable outcome (mean preference value, 0.0:95% confidence intervals, -0.05 to 0.05) and worse than a 100% risk of dying before graft loss (0.17: 0.12-0.23). Graft duration of 5 years had the same preference scores (ie, as bad) as the maximum risk of all adverse outcomes including a 100% risk of dying before graft failure. To achieve zero risk of cancer, dying, and cardiovascular disease participants were only willing to trade 3.1(2.1 to 4.7), 1.7(1.1 to 2.5), and 1.2(0.8 to 1.8) years of graft survival, respectively, and less than 1 year for all other outcomes. Conclusions: Transplant recipients regarded graft loss as worse than death and showed minimal willingness to trade a reduction in this outcome with an improvement in any other outcome.