*Purpose: BK viremia and BK nephropathy (BKN) are common after kidney transplant alone, occurring in ~15% and ~1-10%, and are associated with an increased risk of graft failure. Simultaneous pancreas-kidney (SPK) recipients are also at risk of BK infection. There are limited data on the timing and incidence of BK viremia after SPK in patients who undergo routine screening, and what the impact of BK viremia is on kidney and pancreas transplant outcomes in a screened SPK population.

*Methods: We performed a single-center retrospective study of SPK recipients from 1/2008-7/2021. We excluded patients with death or kidney graft failure within 30 days of transplant. Induction immunosuppression (IS) was thymoglobulin 10.5 mg/kg and rapid steroid withdrawal. Maintenance IS was tacrolimus and mycophenolate. Serum BK PCR screening was performed monthly, with reduction in IS when positive. Kidney failure defined as death or return to dialysis. Pancreas failure defined as death, pancreatectomy, or return to insulin of > 0.5 U/kg/d for >90d.

*Results: The cohort included 81 SPK recipients, 20 (25%) developed BK viremia at a median of 91d (IQR 54-373, range 32-1546). Recipient characteristics shown in table. Only 3 patients had kidney rejection prior to diagnosis of BK. 5/20 (25%) of BK patients developed BKN. After IS reduction for BK, 3/20 (15%) patients had kidney rejection and 3/20 (15%) patients had both kidney and pancreas rejection. No pancreas failures occurred after IS reduction for BK, and only 1 kidney failed due to BK nephropathy. Creatinine and A1c were similar in both groups at last follow up.

*Conclusions: BK viremia is common after SPK. However, with screening and IS reduction when viremia develops, kidney failure from BKN is uncommon. Despite needing to reduce IS to control BK infection, long-term kidney and pancreas allograft function and outcomes are excellent.

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