This retrospective observational study illustrates 30 years of experience of Therapeutic Plasma Exchange in 35 cases out of 1210 kidney transplantations performed between 1990 till 2020. Total 11 patients underwent Plex before undergoing kidney transplantation whereas 24 patients underwent Plex post kidney transplantation. Pre-transplant therapeutic plasma exchange was done in 5 Human Leukocyte Antigen incompatible, 5 ABO incompatible kidney transplant prospects and 1 prospective recipient with monoclonal gammopathy of renal significance. Whereas 15 kidney transplant recipients (Kidney Transplant Recipients) with antibody mediated rejection, 6 Kidney Transplant Recipients with thrombotic microangiopathy, 1 with myeloma cast nephropathy, 1 recurrence of Focal Segmental Glomerulosclerosis post transplantation & 1 Anti-Glomerular Basement Membrane antibody positive Kidney Transplant Recipient underwent Plex. The clinical end point after Plex exchange was achieved in 23 patients, 6 patients had a partial response. There was no response after Plex done for Kidney Transplant Recipient with Anti-Glomerular Basement Membrane antibody positive transplant glomerulopathy who subsequently progressed to requiring maintenance dialysis