Treatment of renal allograft rejection by exchange plasma-lymphocytapheresis

Therapy for acute renal allograft rejection generally consists of administration of high doses of corticosteroids along with cytotoxic drugs. Failure of this treatment usually dictates removal of the graft. We describe a patient who was rejecting a renal transplant from his HLA-identical, mixed lymphocyte culture-compatible brother. This acute rejection episode was unresponsive to three days of therapy with high doses of steroids, azathioprine and coumadin. The patient rapidly improved following intensive exchange plasmapheresis and lymphocytapheresis. This therapy produced depletion of immunoglobulins, complement components, coagulation factors and circulating lymphocytes, and resulted in dramatic improvement in renal function and reversal of the rejection crisis. We suggest that intensive pheresis may represent an important adjunct to currently available therapy for the treatment of acute renal allograft rejection.