Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP).Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed.Results Prior to renal transplantation, the platelet count of these two patients was 41 ×109 /L and 34 ×109 /L,respectively.The coagulation function was normal and no active bleeding was observed.They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively.The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation.Though receiving platelet-promoting drugs and platelet infusion,the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10 ×109 /L and 30 ×109 /L after renal transplantation.Renal function was well maintained in both recipients.Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not.Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.