Kidney transplant patients and their spouses (n = 121 couples) rated their overall stress, social support, and adjustment following transplantation. Patients experienced significantly more overall stress than did spouses, although spouses were equally or more stressed than patients on some issues. Patients and spouses did not differ in marital satisfaction, although patients reported significantly more depression than did spouses. Overall stress was related to lower marital satisfaction and increased depression for both patients and spouses. Patients who were experiencing higher stress benefitted more from the support they received from their spouses. Spouses who were less stressed offered more helpful and less unhelpful support to patients. Implications for social work practice are discussed.