Pediatric Transplantation

Leflunomide is a promising adjunctive treatment for BK virus eradication and prevention of BK nephropathy, along with IS reduction, particularly anti-proliferative immunosuppression reduction, without significant risk for the development of biopsy-proven rejection in pediatric kidney transplant recipients. Given the significant risk for the development of biopsy-proven rejection with complete AP discontinuation and CNI reduction in our study cohort, we suggest anti-proliferative reduction, not discontinuation, and judicious reduction in CNI trough goals with close monitoring as a strategy for treatment of BK viremia with concomitant use of leflunomide therapy.