Steroid-resistant rejection (SRAR) is defined as a lack of mprovement of the creatinine concentration within 5-7 days after treatment. The aim of this work is to study the factors that lead to SRAR in first donor renal allograft. Out of 1691 renal transplanted, 207 patients who experienced AR were selected for this retrospective study. Exclusion criteria included patients with antibody mediated rejection. Enrolled patients were compared with those experienced steroid responsive AR for demographic data, history of blood transfusion, degree of HLA matching, donor source; ischemia time; 1ry immunosuppressant, acute tubular necrosis. Basal, peak and post treatment serum creatinine were evaluated for the studies patients in relation to the SRAR episodes. In our study the incidence of SRACR was 15.3%. We did not find that recipient and donor age and sex, donor source, degree of HLA matching, use of induction therapy has no effect on developing SRACR. We observed that >70% of cases developed SRAR within the first month of transplantation and this was correlated with pre-transplant blood transfusion and low CsA trough level. With the use of monoclonal antibodies, plasmaphersis and/or use of rescue therapy there was no difference in the graft outcome when compared to steroid responsive acute rejection episodes. Steroid resistant acute cellular rejection is relatively common after kidney transplantation. Frequent blood transfusion, use of low sub therapeutic doses of CsA could be risk factors for it. Good evaluation and management may help the outcome in these patients.