Malakoplakia has been rarely reported in renal transplant recipients. We discuss two renal transplant recipients with malakoplakia involving renal allografts. Both transplant recipients were managed with reducing the doses of immunosuppressive medications and long-term oral antibiotic therapy. The renal allograft functions remained stable and imaging studies did not show progression of the disease. Our data suggest reducing the immunosuppression and long-term antimicrobial therapy to achieve long-term renal allograft survival.