What changes to immunosuppressant medications do you adopt for kidney transplant patients who contract COVID-19?

It really depends on the severity of their symptoms.

For patients with mild symptoms, we typically lower the MMF somewhat as well as treat with paxlovid as the first line.

Due to the interactions with the CNIs etc., we adopt the following protocol for tacrolimus and paxlovid:

1. Day 1- First Paxlovid dose STOP TACROLIMUS after AM dose (if already taken)
2. Day 2-5- Paxlovid continues Continue HOLD on TACROLIMUS
3. Day 6-8- Paxlovid completed Continue HOLD on TACROLIMUS
4. Day 9- Restart TACROLIMUS at the previous dose
5. Day 11-: Get labs done with a good 12-hour tacrolimus level

If the patient has severe covid requiring hospitalization and supplemental O2, we would adjust anywhere from reducing the MMF and tacrolimus to stopping MMF altogether. If the...