Sustained Response to Eculizumab in a Patient With COVID-19–Associated Acute Thrombotic Microangiopathy of the Allograft Kidney: A Case Report

ABSTRACT

Acute thrombotic microangiopathy (TMA) developing in association with SARS-CoV-2 infection is a rare but recognized phenomenon in native kidneys. In the allograft kidney, a diagnosis of TMA has a broad etiologic differential, including antibody-mediated rejection and recurrent and de novo causes of TMA that affect the native kidney. Prior case reports have described plasma exchange or eculizumab use in patients with COVID-19–associated TMA. Herein, we describe the course of a kidney transplant patient with COVID-19–associated TMA with response to eculizumab that was sustained after medication withdrawal and review the literature on COVID-19–associated TMA of the allograft kidney.