*Purpose: COVID-19 has been reported as a cause of kidney injury and data from published native kidney biopsy results demonstrate a variety of causes. To our knowledge, there are no published series looking specifically at kidney allograft biopsy findings in patients with COVID-19.

*Methods: We identified 10 kidney transplant recipients who underwent allograft biopsy within one month after infection with SARS-CoV-2 virus. We collected data regarding patients’ clinical characteristics, transplant history, COVID-19 illness, and histology and immunohistochemistry findings of the kidney allograft biopsies.

*Results: Patients had a median age of 50.3 years, and four of the patients were female. Demographics included four Hispanics, three Whites, two Blacks, and one unidentified. All patients had co-morbidities, including hypertension in eight and diabetes in three. Cause of allograft biopsy was acute kidney injury (n=9), proteinuria (n=2), and nephrectomy after allograft failure (n=1). 6/10 had developed COVID pneumonia, and two of those required mechanical ventilation.On analysis of histology results, three had severe acute rejection (two with acute T cell rejection – grades 2A and 2B, and one with a mixed rejection), two revealed podocytopathy (one with collapsing glomerulopathy and one with recurrent lupus podocytopathy), one showed cortical necrosis, one had chronic thrombotic microangiopathy/transplant glomerulopathy, one had acute tubular injury, and two showed no specific histologic abnormalities. Immunohistochemical staining for SARS-N-Capsid was negative in 5/5 biopsies where performed.Follow up data including serum creatinine levels was available for 8/10 patients. Of these, only two demonstrated an improvement in kidney function back to baseline. No deaths were reported in the studied population.

*Conclusions: This series of kidney transplant recipients who underwent allograft biopsy after COVID-19 illness demonstrates a wide variety of causes of kidney allograft dysfunction, the most common of which was rejection. Similar to the cases of native kidney dysfunction, we found no evidence of direct viral invasion.

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