Improved graft prognosis by treatment of steroid resistant rejections with ATG and plasmapheresis.

Conventional therapy of acute rejection is almost exclusively based on increased steroid dosage, however, a considerable number of grafts undergo irreversible steroid resistant rejection (SRR). We investigated in a prospective study the effects of antithymocyte globulin (ATG) and plasmafiltration (PF) in cases of SRR. Acute interstitial rejections were treated with ATG, acute vascular rejections with PF. Thirty-nine of 42 (93%) cases of SRR were reversed by these forms of therapy. In 68 recipients of first cadaveric renal allografts actuarial one year graft survival has improved to 88 (+/- 5) per cent since the introduction of ATG and PF for SRR. Severe side effects or increased mortality were not observed, none of the patients with either form of therapy died. Thus ATG and PF are valuable adjuncts in the treatment of SRR.