Kidney Week

Abstract: TH-PO0931

BK Viremia and Adverse Outcomes in Kidney Transplant Recipients: A Multicenter Real-World Analysis Using the TriNetX Global Network

Session Information

• Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Matarneh, Ahmad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Ahmad Matarneh, MD

• Salameh, Omar Khaleel Mohammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Omar Khaleel Mohammad Salameh, MBBS

• Sardar, Sundus, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Sundus Sardar, MD

• Hassan, Abdelsabour, University of Missouri-Kansas City, Kansas City, Missouri, United States

Abdelsabour Hassan, MD

• Shah, Vaqar H., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Vaqar H. Shah, MD

• Karasinski, Amanda A., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Amanda A. Karasinski, MD

• Kaur, Gurwant, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Gurwant Kaur, MD, FASN

• Ghahramani, Nasrollah, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Nasrollah Ghahramani, MD, FASN

Background

BK virus (BKV) reactivation is a common complication after kidney transplantation and may lead to allograft dysfunction, rejection, or loss. However, large-scale outcome data on BKV viremia in transplant recipients remain limited. We used a global electronic health record (EHR) network to compare clinical outcomes in kidney transplant recipients with and without BKV viremia.

Methods

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including data from 148 healthcare organizations. Adult kidney transplant recipients with documented BKV viremia, defined by a positive BK virus DNA test (LOINC 43201-3), were compared to kidney transplant recipients without BKV detection. The index event was the first detection of BKV for the exposed group and transplant diagnosis for controls. Outcomes included all-cause mortality, end-stage renal disease (ESRD; ICD-10 N18.6), graft failure (T86.11), and acute kidney injury (AKI; N17). Risk estimates, odds ratios, and hazard ratios were calculated, and Kaplan-Meier survival analyses were performed.

Results

The BKV viremia cohort included 8,941 patients; the control group included 199,210 transplant recipients without BKV.
Mortality was lower in the BKV group (12.6%) compared to controls (17.2%) (OR 0.70; 95% CI: 0.65–0.74; p<0.001).

ESRD occurred in 58.3% vs. 44.7% (OR 1.73; 95% CI: 1.66–1.81; p<0.001).

Graft failure was more frequent in the BKV group (24.3% vs. 18.1%) (OR 1.45; 95% CI: 1.38–1.53; p<0.001).

AKI was also more common (44.0% vs. 33.2%) (OR 1.58; 95% CI: 1.51–1.65; p<0.001).
Despite lower mortality, BKV viremia was associated with significantly worse renal outcomes.

Conclusion

In this large real-world cohort of kidney transplant recipients, BKV viremia was associated with increased risks of ESRD, graft failure, and AKI. The observed lower mortality in the BKV group may reflect residual confounding, such as survivor or surveillance bias. These findings emphasize the need for improved strategies for monitoring and managing BKV in transplant care.a

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025vm5b954q