ABSTRACT
Background: The outcomes after COVID-19 and the associated immunosuppressive agents modification in kidney graft is unknown. We evaluated the presence of de-novo DSA and histopathologic findings in a group of kidney recipients after COVID-19 infection Methods: Kidney recipients recovered from COVID 19 infection from March 31, 2020 to December 8, 2020 in a single transplant center in Mexico were enrolled. Four weeks after COVID-19 diagnosis, DSA and kidney graft biopsy were performed. Results: A total of 20 kidney transplant recipients were enrolled. Immunosuppressive regimen was modified in 60% of patients, the most common modification was MMF reduction or withdrawn (35%). Allograft biopsy revealed that 70% had rejection;20% were classified as active chronic rejection, 15% active ABMR, 20% mixed ABMR/TCMR rejection, 10% borderline for acute TCMR and 5% acute TCMR. Among allografts diagnosed with rejection, 57% were considered as subclinical. All borderline for acute TCMR and active ABMR with dnDSA were subclinical Conclusions: The unusually high rate of acute rejections and the high number detected without allograft dysfunction in recipients recovered from COVID-19 should be an alert to others transplant centers to monitorize alloimmune response after COVID-19.