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Recent studies show that alexithymia may influence compliance and quality of life in different clinical situations. The aim of this study was to evaluate the associations between alexithymia or emotional self-efficacy and compliance, quality of life (QoL) and renal function in renal transplant patients. Methods Forty-three patients were enrolled during a follow-up visit (> 3 months post-transplant) and were asked to complete three self-report questionnaires (TAS-20, SF-36, RESE) to answer the following items: “In the past four weeks, how many times did you fail to take your prescribed dose?” and “How would you rate your adherence levels from 0 to 100?” (visual analogue scale). Results Alexithymia was positively correlated with non-compliance (r = .314; p = .04), and negatively with QoL dimensions. Analysis of variance confirmed that patients with high levels of alexithymia reported a negative perception of their QoL (mental health: F(1,41) = 7,6; p = .008) and lower levels of compliance (F(1,41) = 12,5; p = .001) compared with patients with low levels of alexithymia. The self-efficacy in the management of negative emotions was significantly correlated (r = − .314; p = .04) with creatinine levels and positively with the QoL (mental health: r = .421; p = .005). Discussion The inability to recognize and express emotions, as well as the ability to manage negative emotions, may influence compliance and QoL of renal transplant patients. Focused psychological support could be useful in these patients in order to increase their compliance and QoL.