Fixed-film biofilm reactors are considered one of the most effective wastewater treatment processes, however, the cost of their plastic bio-carriers makes them less attractive for application in developing countries. This study evaluated loofah sponges, an eco-friendly renewable agricultural product, as bio-carriers in a pilot-scale integrated fixed-film activated sludge (IFAS) system for the treatment of municipal wastewater. Tests showed that pristine loofah sponges disintegrated within two weeks resulting in a decrease in the treatment efficiencies. Accordingly, loofah sponges were modified by coating them with CaCO₃ and polymer. IFAS pilot tests using the modified loofah sponges achieved 83% organic removal and 71% total nitrogen removal and met Vietnam’s wastewater effluent discharge standards. The system achieved considerably high levels of nitrification and it was not limited by the loading rate or dissolved oxygen levels. Cell concentrations in the carriers were twenty to forty times higher than those within the aeration tank. Through 16S-rRNA sequencing, the major micro-organism types identified were Kluyvera cryocrescens, Exiguobacterium indicum, Bacillus tropicus, Aeromonas hydrophila, Enterobacter cloacae, and Pseudomonas turukhanskensis. This study demonstrated that although modified loofah sponges are effective renewable bio-carriers for municipal wastewater treatment, longer-term testing is recommended.