*Purpose: To determine the development of de novodonor specific antibodies (DSA) in renal transplant recipients with immunosuppression modulation and BK viremia and the associated risk of AMR.

*Methods: After IRB approval, data on all renal transplant recipients (RTR) from 2007 to 2017 at our center who develop BK viremia >10,000 copies/ml or biopsy proven BKVN, with DSA and biopsy reports from the time of BK diagnosis and 1 year follow up data were retrospectively collected. Data was extracted from the Enterprise Data Warehouse and primary review of biopsy and HLA laboratory data. We defined de novo DSA as DSA that was not detected either pre-transplant or post-transplant until the immunosuppression modulation.

*Results: 248/1911 (12.9%) RTR had BK viremia or biopsy proven BKVN. Of these, 37 (14.9%) developed de novo DSA during the 1 year follow up and after the immunosuppression reduction. 203 (81.8%) of studied patients had biopsies performed during the 1 year follow up. Rejection was noted on 33 (16.2%) of biopsied patients; 13 (39.3%) of these represented AMR. 6 (16.2%) patients with de novoDSA developed AMR representing. While data collection is still ongoing, this rate of AMR appears higher than the rate seen in our entire RTR population (~13%).

*Conclusions: Development of de novoDSA after the immunosuppression reduction for BKVN management occurs in a minority of patients but is associated with a risk of AMR. Further data is needed to determine the rate of de novo DSA and AMR in patients with and without BK.

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