To define the efficacy of plasmapheresis performed as part of combined treatment for steroid-resistant patterns of acute rejection of a renal transplant, the results of the treatment were analysed in 11 patients. The analysis also involved the results of plasmapheresis treatment of 3 patients with terminal renal failure complicated with septic conditions and 1 patient with stenosed artery of the transplanted kidney and irreversible arterial hypertension. Plasmapheresis was used in various terms of rejection after a 3-4-day prednisolone pulsatile therapy. The effect of the procedure was recorded in 7 out of 13 patients, i. e. in 50 per cent of those treated. The necessity of applying early plasmapheresis (immediately after methylprednisolone pulsatile therapy in case of its failure) was demonstrated as were the methods of intensive plasmapheresis performance (daily within 4-5 days). The technique permitted to eliminate septic conditions before and after the period of transplantation, to decrease blood pressure in the patients with stenosed arteries of transplanted kidney. The authors considered the mechanism of the curative effect of plasmapheresis in the patients with acute rejection and the criteria for its efficiency.