# Concurrent Banff 2A Acute Cellular Rejection and BK Virus Nephropathy in a Kidney Transplant Recipient: A Case Report and Review of Management Strategies

## TL;DR

This case report describes a kidney transplant patient who faced both acute rejection and a BK virus infection, highlighting the difficulty in managing these conditions.

## Contribution

The paper presents a rare concurrent case of Banff 2A rejection and BK virus nephropathy, emphasizing evidence-based management strategies.

## Key findings

- The patient experienced delayed graft function and wound complications after transplant.
- Appropriate immunosuppression and antiviral prophylaxis helped stabilize the patient.
- The case underscores the challenges in balancing immunosuppression to prevent rejection and viral activation.

## Abstract

We present a complex case of a 71-year-old man with end-stage renal disease secondary to autosomal dominant polycystic kidney disease who developed acute Banff 2A cellular rejection in association with BK virus nephropathy following a deceased donor kidney transplant. Despite the initial delayed graft function and subsequent wound complications, the patient stabilized with appropriate immunosuppression and antiviral prophylaxis. This case highlights the challenges of balancing immunosuppression for the management of graft rejection while minimizing viral activation, with an emphasis on evidence-based management of BK polyomavirus.