*Purpose: West Nile viral encephalitis is uncommon but can lead to permanent neurological damage. Transplant related West Nile viral disease has been described before; however, data in kidney transplant recipients is limited.

*Methods: A retrospective chart review of all the patients at our institution with a history of kidney transplant and West Nile virus diagnosis between 1994 – 2018 was performed.

*Results: During the 23-year study period, 11 patients had documented West-Nile virus infection. Seven patients had kidney alone transplant, and four had simultaneous kidney and pancreas transplant. The mean age at time of transplant was 44.7 ± 17.1 years. Induction agents included Alemtuzumab (n = 2), OKT3 (n = 1) and anti-thymocyte globulin (n = 8). Three patients were treated for rejection within six months before the infection. The mean time from the transplant to the West Nile viral infection was 3.4 ± 5.4 years. The most common presentation was altered mental status (n = 7), followed by headaches with fevers (n = 4). All the patients had West Nile virus IgM antibodies in serum at the time of diagnosis. Only two patients received weekly IVIG as part of their treatment; all patients had a reduction in their immunosuppression. Nine patients recovered with no residual deficit; two suffered permanent neurological damage. The mean eGFR drop at one year after infection was 8.4 ± 13 ml/min/1.73 m² (mean eGFR at time of infection was 59.5 ± 16 ml/min/1.73 m² and one year after infection was 46.4 ± 27 ml/min/1.73 m²). Two patients suffered acute rejection within one year after the infection episode due to reduction in immunosuppression. The mean follow up after infection was 5.1 ± 4.3. By the last follow-up, two patients lost their kidney allograft, and five patients died. None of the graft losses or deaths occurred within a year of the West Nile infection.

*Conclusions: To the best of our knowledge, this is the largest case-series of West Nile virus infection in kidney transplant recipients. The role of IVIG in these cases is poorly defined, but the majority of patients recovered fully just with conservative management. Kidney complications were not common but a gradual decline in eGFR at one year after infection is noted.

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