Table 1.

Serial Serum Creatinine, Tacrolimus Level, dd-cfDNA, and COVID-19 Tests During Hospitalization and Postdischarge^∗

	Hospital Day 1	Hospital Day 14	Hospital Day 16 (Discharge Day)	Day 14 Postdischarge	Day 35 Postdischarge	Day 56 Postdischarge	Day 70 Postdischarge	Day 73 Postdischarge (Second Admission)	Day 77 (Biopsy Date)
Serum creatinine (mg/dL)	2.6	1.8	1.9	1.64	1.57	1.69	1.8	1.7	2.0
Tacrolimus level (ng/mL)	3.9	5.6	4.1	5.1	7.3	5.2	6.1	9.2	8.5
dd-cfDNA (%)	---	4.3	---	7.8	2.6	2.8	3.5	---	---
Follow-up COVID-19 tests (NP NAT)	---	---	---	Positive	Positive	---	Positive	---	Negative on day 78 postdischarge

COVID-19, coronavirus disease 2019; dd-cfDNA, donor-derived cell-free DNA; NP NAT, nasopharyngeal swab nucleic acid amplification test.

Baseline (1 year prior to presentation): Very low-level DSAs to HLA-DR7 and -DR53. These DSAs were well below a level sufficient to yield a positive flow cytometric crossmatch.

Hospital day 12: Continued presence of DSAs to HLA-DR7 and -DR53. Of concern, DSAs to HLA-DQA2/DQB2 were present at a level compatible with a positive cytotoxicity crossmatch.

Hospital day 14: continued presence of DSA to HLA-DR7, -DR53, -DQA2/DQB2. Of concern, DSAs to HLA-DQA2/DQB9 and -DP20 were present at a level compatible with a positive cytotoxicity crossmatch.

Postdischarge day 70: Continued presence of DSAs to HLA-DR53, -DQA2/DQB9, and -DQA2/DQB2. DSAs to HLA-DR7 and -DP20 had decreased and were below a level considered positive. Collectively, the DSAs were at a level sufficient to yield a positive cytotoxicity crossmatch.

^∗Note HLA donor-specific antibodies as follows (transplant candidates and their deceased donors were typed for HLA-A, -B, -C, -DR, -DQ, and -DP by reverse sequence-specific oligonucleotide assay (One Lambda LABType), as described by Lucas et al [17]).