Table 1.

Immunosuppression Strategies Used

Treatments	After the first HT (November 2018)	Before readmission (December 2019)	During the treatment of lymphoma (January 2020)	During SARS-CoV-2 infection (March 2020)	After the second HT (May 2020)
Induction/acute rejection treatments
Antibodies	rATG IV 1.5 mg/kg daily (2 days) 1 mg/kg daily (1 day)	N/A	N/A	rATG IV 1.5 mg/kg daily (3 days)	No induction
Corticosteroids	N/A	N/A	N/A	Methylprednisolone IV 500 mg daily (3 days)
Maintenance treatments
Calcineurin inhibitor	Tacrolimus q12h from POD 5 onward (target 8–12 ng/ml)	Tacrolimus q12h (target 8–10 ng/ml)	Tacrolimus q12h (target 5–7 ng/ml)	Tacrolimus q12h (target 6–8 ng/ml)	Cyclosporine IV daily (target 250–300 ng/ml) followed by tacrolimus q12h (target 8–12 ng/ml) from POD 5 onward
Anti-metabolite	MMF 500 mg q8h	MMF 750 mg q12h	MPA 180 mg q12h	MPA 360 mg q12h	MMP 1 g q8h
Corticosteroids	Methylprednisolone IV 2 mg/kg daily POD 1 1 mg/kg daily PODs 2–7 Biopsy-guided tapering of prednisone from POD 8 onward	Prednisone 5 mg daily	Prednisone 5 mg daily	Prednisone 30 mg daily	Methylprednisolone IV 2 mg/kg daily POD 1 1 mg/kg daily PODs 2–7 Slow biopsy-guided tapering of prednisone from POD 8 onward
Other relevant treatments	N/A	N/A	Rituximab (4 cycles) 375 mg/m² per cycle	Lopinavir/ritonavir q12h (14 days) ECMO (21 days)	Rituximab on hold

Abbreviations: ECMO, extracorporeal membrane oxygenation; HT, heart transplantation; IV, intravenous; MMF, mycophenolate mofetil; MPA, mycophenolic acid; N/A, not applicable; POD, post-operative day; q8h, every 8 hours; q12h, every 12 hours; rATG, rabbit anti-thymocyte globulin; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.