Concurrent Banff 2A Acute Cellular Rejection and BK Virus Nephropathy in a Kidney Transplant Recipient: A Case Report and Review of Management Strategies.

We present a complex case of a 71-year-old man with end-stage renal disease secondary to autosomal dominant polycystic kidney disease who developed acute Banff 2A cellular rejection in association with BK virus nephropathy following a deceased donor kidney transplant. Despite the initial delayed graft function and subsequent wound complications, the patient stabilized with appropriate immunosuppression and antiviral prophylaxis. This case highlights the challenges of balancing immunosuppression for the management of graft rejection while minimizing viral activation, with an emphasis on evidence-based management of BK polyomavirus.