Abstract The aim of the present study was to assess adolescent renal transplant recipients' perceived adversity (PA) for various aspects of living with a transplant, including its association with coping and medication nonadherence, from a theoretical perspective. Thirty-three adolescent renal transplant recipients were interviewed using structured questionnaires and medical record reviews. Health care provider ratings of adversity were also collected. Participants reported moderate levels of PA, with those who received a transplant at an older age reporting more adversity on several domains and girls reporting more adversity for missing school. Ratings of adversity for specific aspects of living with a transplant differed depending on age and medical factors and were related to specific coping strategies and measures of non-adherence. Consistent with the Self-Regulation Model, perceived consequences (represented as PA) appears to be related to coping and illness outcomes. Assessing PA and teaching appropriate coping strategies may yield better medical outcomes among this at-risk population