*Purpose: To verify the frequency of BKVAN in a single center’s clinical setting and evaluate the response to immunosuppressive adjustments through graft survival analysis.

*Methods: Retrospective evaluation of a cohort of kidney transplant recipients with biopsy-proven BKVAN, compared with no-BKVAN patients regarding clinical aspects, immunosuppression and graft survival over at least 2 years.

*Results: There were 1404 kidney transplants analysed in the study period, and 58 patients were diagnosed with biopsy-proven BKVAN. The cumulative incidence was 4.1% during follow-up: 2%, 3.1% and 4% in 6, 12, 24 months after transplantation, respectively. Median time from transplantation to BKVAN diagnosis was 187 (61-1275) days. BKVAN was associated with recipient male gender (p = 0.042), deceased donor (p = 0.007) and preexisting diabetes (p = 0.017). Twenty-one (36.2%) patients had at least an acute rejection episode before BKVAN, and twelve (20.6%) after BKVAN diagnosis and IS reduction. Graft survival was inferior for BKVAN compared to non-BKVAN patients (p = 0.019). Survival in 5 years was inferior for Banff stages B/C (69.7%) compared to stage A (80.8%) and non-BKVAN patients (88.0%) (p = 0.017). Thirteen (22.4%) BKVAN patients lost their grafts, 9 (15.5%) attributed to BKV infection. Three patients with BKV-associated graft losses were submitted to a successful second kidney transplant, with no evidence of viral replication (follow-up of 7, 12 and 31 months).

*Conclusions: The cumulative incidence of BKVAN in our study was 4.1%. Despite of immunosuppression reduction there was a significant lower graft survival in BKVAN, specially in grades B and C.

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