Background: Pandemic H1N1 infection has been associated with significant morbidity in general population. Immuno compromised transplanted patients are one of at risk groups. Handling of immunosuppressive drugs in such population was not discussed in details in literatures.Patients &Methods: Fifty-two renal transplants recipients (RTR) started oseltamivir upon clinical suspicion. 25/52 of them were proved to suffer from H1N1. Nasopharyngeal swabs were subjected to specific testing for H1N1 by standard methodology using real-time reverse transcriptase polymerase chain reaction (RT-PCR). Of the confirmed cases; 21 patients were admitted and isolated due to pneumonia, bronchitis, gastroenteritis and or shock while the other 4 patients treated on outpatient basis.Results: Twelve cases suffered from respiratory symptoms; six cases suffered from H1N1 pneumonia, while other 6 cases suffered from acute bronchitis. The other 13 admitted patients suffered from gastroenteritis, high fever and or shock. Twenty-three out of 25 RTR showed dramatic response to oseltamivir, high grade fever resolved 1-2 days after initiation of the antiviral drug. Most of patients discharged to home 4-6 days after admission. Conclusion:Early clinical suspicion and starting oseltamivir immediately upon clinical suspicion is to decrease the morbidity and mortality. Doubling the dose, extension of duration of treatment and reduction of immunosuppressive drugs (when indicated) are the keys for successful management of H1N1 infection in RTR.