Table 3.

Evolution of hospitalized patients with occurrence of post–COVID-19 DSA

Characteristics	P1	P2	P3	P4	P5	P6	P7
Sex	M	M	M	M	M	M	M
Age (yr)	32	19	61	72	20	61	52
Transplant rank	1	2	1	1	1	1	1
Time from transplantation (yr)	5	1	0	9	2	1	0
Maintenance therapy
CNI	Yes	No	Yes	Yes	Yes	Yes	Yes
MMF	No	No	Yes	Yes	Yes	Yes	Yes
Steroids	Yes	Yes	No	No	Yes	Yes	No
Other	No	IV-Ig	No	No	No	No	No
ICU admission	No	No	Yes	No	No	No	No
CRP highest level (mg/l)	16	5.2	95	61	147	NA	108
Lymphocyte lowest count (/mm3)	750	1600	120	550	710	NA	80
Management of immunosuppression
CNI	Continue	—	Stop	Stop	Continue	Stop	Continue
MMF/MPA	—	—	Stop	Stop	Stop	Stop	Stop
Time from CNI resumption (d)	0	—	14	3	0	21	0
Time from MPA resumption (d)	—	—	42	21	13	21	42
COVID-19 treatment	None	None	DXM	Other	Other	None	DXM
Increase in SCr	No	Yesa	NAb	No	No	No	No
Proteinuria (g/24 h)	No	0.4	1	No	No	No	No
De novo DSA
Anti HLA class I	No	Yes	No	Yes	No	No	Yes
Anti HLA class II	Yes	No	Yes	No	Yes	Yes	Yes
Highest MFI	4450	13180	2200	4000	2000	2000	11600
Biopsy	No	Yes	Yes	Yes	Yes	Yes	No
Rejection	NA	ABMR	ABMR + TCMR	cABMR	None	None	NA
Treatment	None	None	Yesc	Yesd	IV-Ig	None	None
Evolution of allograft function	CKD I	CKD IV	CKD III	CKD II	CKD II	CKD I	CKD III

ABMR, antibody-mediated rejection; cABMR, chronic antibody-mediated rejection; CNI, calcineurin inhibitor; CRP, C-reactive protein; DSA, donor-specific antibody; DXM, dexamethasone; ICU, intensive care unit; MFI, mean fluorescence index; MMF, mycophenolate mofetil; MPA, mycophenolic acid; TCMR, T-cell mediated rejection.

^aSerum creatininemia increased from 90 μmol/l to 130 μmol/l.

^bCOVID-19 developed immediately after transplantation with delayed graft function during the first weeks post-transplantation.

^cSteroid pulse + plasma exchange + i.v. immunoglobulin.

^dReinforcement of maintenance immunosuppressive therapy (i.e., increasing in CNI trough level objectives and antimetabolite dosage plus oral steroid therapy).