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Kidney transplant recipients (KTRs) are prone to develop severe COVID-19 and are less well protected by vaccine than immunocompetent subjects. Thus, the use of neutralizing anti-SARS-CoV-2 monoclonal antibody (MoAb) to confer a passive immunity appears attractive in KTRs.We performed a French nationwide study to compare COVID-19-related hospitalization, 30-day admission to intensive care unit (ICU), and 30-day death between KTRs who received an early infusion of MoAb (MoAb group) and KTRs who did not (control group). Controls were identified from the COVID-SFT registry (NCT04360707) using a propensity score matching with the following covariates: age, sex, delay between transplantation and infection, induction and maintenance immunosuppressive therapy, initial symptoms, and comorbidities.A total of 80 KTRs received MoAb between February 2021 and June 2021. They were matched to 155 controls. COVID-19-related hospitalization, 30-day admission to ICU, and 30-day death were less frequently observed in the MoAb group (35.0% vs. 49.7%,The early use of MoAb in KTRs with a mild form of COVID-19 largely improved outcomes in KTRs.

Introduction Decreased immunosuppression has been proposed for kidney transplant recipients infected with Covid-19 but the impact on the alloreactive immune response during and after infection has been poorly investigated. We assessed the occurrence of anti HLA donor specific antibodies (post-Covid DSA) and rejection episodes following Covid-19 with particular focus on immunosuppression modulation. Methods Kidney transplant recipients from two French institutions had anti-HLA antibody screening before and after Covid-19. Management of immunosuppression, rejection episodes, Covid-19 severity, inflammatory markers and antiviral therapies were recorded. Results From 251 recruited patients, 72 were excluded because of Covid-19 related death (n= 25) and incomplete immunological follow-up (n= 47). Among the remaining 179 included patients, almost half were hospitalized (49.2%). Antimetabolites were interrupted in 47% of patients (82% in hospitalized, median time of resumption of 23 days and in 15% non-hospitalized, median time of resumption of 7 days). Calcineurin inhibitors were interrupted in 12% of patients (all hospitalized, median time of resumption of 11 days). The incidence of post-Covid DSA was 4% (8% and 0% in hospitalized and non-hospitalized, respectively). Allograft rejection occurred in 3 patients (1.7%) and all were hospitalized. Younger age, transplantation less than one year and preexisting DSA were more frequently observed in post-Covid DSA positive patients, whereas inflammatory markers, lymphopenia and use of antiviral therapies were not. Conclusion The incidence of post-Covid DSA among Covid-19 positive kidney transplant recipients was low (4%) despite a significant decrease in immunosuppression and was mainly restricted to high-risk immunological patient’s status. Covid-19 severity was not associated with post-Covid DSA and/or rejection., Graphical abstract