Familial relationship after kidney transplantation has an important role in graft and patient's survival by affecting the recipient’s compliance to treatment. It would be helpful to study the contributing factors to familial relationship and marital satisfaction in this population. The aim of this study was to identify the predictors of poor post-renal transplant marital satisfaction.We conducted a cross-sectional study on 125 married kidney transplanted patients in Iran, 2006. Marital satisfaction was evaluated using the Marital Adjustment Scale (MAS). We considered the poor marital satisfaction as a score below the forth quartile of age and sex matched healthy controls’ MAS score. Patients were then grouped into “normal” and “poor” marital states. We used multiple logistic regression analysis to evaluate the predictors of poor marital satisfaction. The mean time interval between assessment of marital satisfaction and transplantation was 43 ±15 months. Post-renal transplant marital satisfaction could be predicted by kidney recipients’ sex (M/F) (OR, 0.31; 95%CI, 0.11-0.90; P=0.031), age at transplantation (OR, 0.93; 95%CI, 0.89-0.98; P=0.005), educational level (OR, 0.67; 95%CI, 0.44-1.03; P=0.067) and total family income (OR, 2.20; 95%CI, 1.09-4.44; P=0.028). This study presented a prediction model for post-renal transplant marital satisfaction, using simple demographic variables. Because all these variables are easy to measure, even before transplantation, it would be possible to detect the high risk patients and apply family therapy modalities for prevention of poor marital satisfaction. This may decrease the risk of noncompliance in kidney recipients and improve their outcomes.