Table 2.

Immunosuppressive protocol in kidney transplant patients with COVID-19 infection in Iran hospitals.

Kidney transplant patients with COVID-19	Immunosuppression management	References
Mild infection	(i) In case of high risk of transplant rejection, continue immunosuppressant with the minimum effective dose (ii) If possible, reduce immunosuppression by discontinuing anti-metabolite drugs (mycophenolate, azathioprine)/family of mTOR inhibitors and continue administration of prednisolone and CNI with minimal effective blood concentration (iii) In mycophenolate+ mTOR inhibitor receiving patients, replace mTOR inhibitor with CNIs	([10], [37], [2])
Moderate to severe infection	(i) Continue prednisolone regimen with stress dose or replace it with intravenous hydrocortisone in case of shock (ii) If possible, disconnect other immunosuppressant agents (iii) In case of high risk of transplant rejection, discontinue antimetabolite immunosuppressants (mycophenolate, azathioprine)/mTOR inhibitors and replace mTOR inhibitor to CNI with minimal effective blood concentration (iv) In lupinavir/ritonavir or atazanavir/ritonavir treaed patients, usually even with discontinuation of mTOR and CNI inhibitors, adequate blood concentration of these immunosuppressants due to the prohibition of their metabolism continues during the course of antiviral therapy	([50], [10], [38], [2])