Plasmapheresis--adjunctive treatment for steroid-resistant rejection in renal transplantation

Plasmapheresis was used to treat steroid-resistant rejection in 32 of 154 patients (21.1 per cent) receiving renal allografts during a 3 1/2-year interval. The 2-year actuarial patient and allograft survival rates for the 32 patients were 93.3 plus or minus 5 and 56.9 plus or minus 9 per cent, respectively. Mean patient followup was 18.8 months. No immunologic rebound was noted in any of the 19 patients who responded initially to plasma exchange. Although 14 of these 19 patients had peak creatinine levels of 4 to 14.5 mg. per cent during the rejection reactions significant and sustained improvement in renal function was noted. This was not a controlled trial but the results are sufficiently encouraging to warrant continued evaluation of plasmapheresis as a therapeutic adjuvant in the treatment of humoral or steroid-resistant rejection.