*Purpose: Prophylaxis for kidney transplant recipients has successfully lowered early incidence of infections such as CMV. However, there are no approved agents for the prevention of BKV infection. Fluoroquinolone prophylaxis over 1 and 3 month durations has demonstrated mixed results

*Methods: We retrospectively evaluated the 1 year incidence of BK viremia in patients who did (n=15) or did not (n=76) receive 6 months of fluoroquinolones post-transplant (levofloxacin 250 mg daily, or ciprofloxacin 250-500 daily, fixed dosing). Inclusion criteria included BK viremia screening that was performed at least twice during the first-year post transplant including one screening at the one year post-transplant mark. We compared patient and transplant demographics, induction and maintenance immunosuppression, and graft function. The primary outcome was the 1 year incidence of BK viremia

*Results: The groups did not differ significantly in demographic/transplant variables (Table 1). The no prophylaxis groups had lower tacrolimus trough levels at 6 months post transplant (p=0.0364) and received lower doses of steroids at 12 months post transplant (p=0.0181). The median number of BK screening tests over 1 year was 4 and 6 in the 6 month prophylaxis and no prophylaxis groups, respectively (p<0.0001). The incidence of BK viremia at one year was 6.7% and 25% in the 6 month prophylaxis and no prophylaxis groups, respectively (p=0.1171). There were no cases of BK virus associated nephropathy in either group. Three cases of acute rejection developed in the no prophylaxis group, while one case developed in the 6 month prophylaxis group (p=0.6387). In the 6 month prophylaxis group, there were no incidences of tendonitis or tendon rupture during the prophylaxis period

*Conclusions: 6 months of fluoroquinolone prophylaxis resulted in a numerically lower incidence of BK viremia that was not statistically significant. Though the prophylaxis group had fewer BK screening tests, all patients had screening at the 1 year mark that we hypothesize should have detected the presence of BK viremia as immunosuppression was otherwise unchanged. This strategy and its safety warrant evaluation in a larger cohort of patients

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