Indication for the steroid therapy for acute rejection

Between January 1, 1986 and March 31, 1997, 103 kidney transplantations were performed at our institution. Seventy-nine grafts were from living related donors; one was from a living unrelated donor; 23 were from cadaveric donors. Basic immunosuppression consisted of cyclosporin (CYA), azathioprine (AZ) and methylprednisolone (MP). Twenty of these grafts (14.9%) developed steroid resistant rejection (SRR). The 5-year graft survival rate of patients with SRR (57.9%) was lower than that with no rejection (92.9%) and steroid responded rejection ( 85.6%). (p = 0.002) Treatment methods of SRR were methylprednisolone pulse (n = 5), plasma exchange (n = 7) and others (n = 8) such as, OKT 3, 15-deoxyspergualin, anti-thymocyte globulin, Tacrolimus rescue and cyclosporin rescue. No significant differences could be seen on the 5-year graft survival between the 3 groups. We reviewed 9 episodes of acute rejection, and compared the Banff classification with the degree of reversibility of rejection. Of the 9 biopsies examined, 5 were classified as borderline change, 2 had mild rejection (grade I), 2 had moderate rejection (grade II), 1 had severe rejection (grade III). Complete reversal of rejection by steroids was observed in only 3 patients; 2 were borderline and one was grade II.