“…This finding is not altogether unexpected, given that the appearance of dnDSA has been seen in other scenarios where lowered immunosuppression is used, such as in cases of medication non-adherence (18,21) or physician-directed immunosuppression minimization (14,(22)(23)(24). Furthermore, we also found that immunosuppression reduction, in this largely African-American cohort, led to a higher rate of acute rejection after BKPyV viremia than seen before (10,25).…”