{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:42:14Z","timestamp":1753879334460,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>BK viremia after kidney transplantation (KT) poses significant risk for BK virus\u2010associated nephropathy and impacts graft survival. Conventional treatment involves reduction of immunosuppression, which in turn may increase risk for rejection. To address this dilemma, use of anti\u2010viral therapy with immunosuppressive properties such as leflunomide is an attractive option.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a multi\u2010center, retrospective chart review to report tolerability and effectiveness of leflunomide use for the eradication of BK viremia and prevention of BK virus\u2010associated nephropathy in pediatric KT recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy patients prescribed leflunomide were included and were followed up from initiation until 1\u2009year following leflunomide completion. BK viremia was eradicated in 64 (91.4%) patients including 8 of 11 with nephropathy (BKVN) on initial biopsy. Reduced anti\u2010proliferative medication (AP) dosing was not associated with increase in biopsy proven rejection (BPAR). However, complete discontinuation of AP during leflunomide therapy was associated with increase in BPAR in uni\u2010 and multivariate logistic regression, as was targeted reduction in calcineurin inhibitor (CNI) trough goals. One graft was lost to BKVN. There was no significant association found between time to BK eradication and leflunomide trough concentration, mycophenolate dose reduction, or steroid use (univariate logistic regression). Few leflunomide adverse drug reactions (ADR) were reported (most commonly: gastrointestinal, hematologic).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Leflunomide is a promising adjunctive treatment to immunosuppression reduction for BK virus eradication with minimal ADR. AP reduction, not discontinuation, and judicious reduction in CNI trough goals with close monitoring, is a promising strategy for treatment of BK viremia with concomitant use of leflunomide therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14724","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T11:24:46Z","timestamp":1709810686000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Leflunomide as adjunct therapy for <scp>BK<\/scp> viremia management in pediatric kidney transplant recipients"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1128-4814","authenticated-orcid":false,"given":"Alexandra","family":"Aldieri","sequence":"first","affiliation":[{"name":"Pharmacy Phoenix Children's Hospital  Pheonix Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Chandran","sequence":"additional","affiliation":[{"name":"Pharmacy University of North Carolina Health  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4463-9493","authenticated-orcid":false,"given":"Debora","family":"Matossian","sequence":"additional","affiliation":[{"name":"Pediatrics, Nephrology, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aparna","family":"Hariprasad","sequence":"additional","affiliation":[{"name":"Pediatrics, Nephrology, Ann &amp; Robert H. 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