Acute vascular rejection treated by plasma exchange.

The vast majority of grafts with acute vascular rejection (AVR) undergoes irreversible loss of function, since this type of rejection usually does not respond to increased immunosuppression. Since 1980 we have treated in 22 patients 27 steroid resistant AVR by plasmafiltration (PF). Per episode 6 x 5 L plasma were filtered and simultaneously replaced by 3.5% Albumin-Ringer-lactate. After each PF 20 g immunoglobulins (Intraglobin(R] was substituted i.v.. In all cases renal function improved following PF. In the long run 1 graft was lost due to chronic irreversible vascular rejection, in 2 patients rejection was not reversed by PF, all others are still functioning, 19 of them 6 months and 8 of them 12 months post PF treatment. They show no signs of rejection. PF with repletion of immunoglobulins after treatment is a simple and safe procedure, which in our hands proved to be quite effectful in reversal of AVR.