What is your approach to managing a kidney transplant patient who develops BK viremia after treatment for rejection?

This is always a challenging situation. First, I decrease the mycophenolate, typically by 50%. Some of my management depends on whether the rejection was antibody mediated vs cellular, and how high the BK viral load is. If there was antibody mediated, I prefer to maintain some mycophenolate, if possible, and have a low threshold to initiate IVIG as that may help both the BK through passive immunity and the antibody mediated rejection. If the patient had cellular rejection, I am more comfortable ...