Purpose:

The objective was to evaluate the use of leflunomide in BK viremia (BKV) and biopsy proven BK nephropathy (BKN) in kidney and kidney-pancreas transplant recipients.

Methods:

We retrospectively reviewed 28 kidney and kidney-pancreas transplant recipients that received leflunomide for BKV from January 2006 to November 2012. Demographics, time to BKV diagnosis, biopsy history, rejection episodes, and laboratory data were recorded.

Results:

The average (mean ± SD) time to BKV diagnosis from time of transplant was 316.1 ± 368.0 days (62-1708). At time of diagnosis, 64% of patients had their maintenance immunosuppression reduced. Leflunomide was started in patients with BKV and biopsy proven acute rejection (BPAR) (50%) or biopsy proven BKN (18%). Therapeutic level (50-100 mcg/mL) was achieved in 54% of patients, and 60% of these required a leflunomide dose of at least 60 mg/day. BK virus was cleared from the serum on average of 151 ± 145.2 days (17-476). Twenty-nine percent of patients never cleared the virus. At study commencement, 29% of patients remained on leflunomide due to persistent BKV or as maintenance immunosuppression.

Conclusion:

In our study, most patients required at least a 60 mg daily dose of leflunomide to achieve therapeutic levels and to clear the virus compared to the standard 40 mg daily dose. Delaying therapy may result in progressive BKV or BKN.

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