Prevalence of BK virus and BK virus-associated hemorrhagic cystitis in stem cell transplant recipients: a systematic review and meta-analysis

doi:10.1007/s11255-025-04507-0

Review

. 2025 Apr 10.

doi: 10.1007/s11255-025-04507-0. Online ahead of print.

Prevalence of BK virus and BK virus-associated hemorrhagic cystitis in stem cell transplant recipients: a systematic review and meta-analysis

Ambanna Yappalparvi^#¹, Mahalaqua Nazli Khatib^#², Muhammed Shabil^{3

4}, Suhas Ballal⁵, Pooja Bansal⁶, Balvir S Tomar⁷, Pranchal Rajput⁸, Ashish Singh Chauhan⁹, MRavi Kumar¹⁰, Abhay M Gaidhane¹¹, Priyanka Choudhary¹², Sanjit Sah^{13

14

15}, Diptismita Jena¹⁶, Ganesh Bushi¹⁷, Doddolla Lingamaiah¹⁸

Affiliations

¹ Centre Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University,, Rajpura, India.
² Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
³ University Center for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India.
⁴ Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001, Hillah, Babil, Iraq.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India.
⁶ Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India.
⁷ Institute of Pediatric Gastroenterology and Hepatology, NIMS University, Jaipur, India.
⁸ School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University Dehradun, Dehradun, India.
⁹ Department of Pharmaceutics, Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, Uttarakhand, 248007, India.
¹⁰ Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India.
¹¹ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
¹² Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Rampura Phul, Bathinda, Punjab, 151103, India.
¹³ Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁴ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁵ SR Sanjeevani Hospital, Kalyanpur, Siraha, 56517, Nepal.
¹⁶ Computer Science and Engineering, Graphic Era (Deemed to Be University), Clement Town, Dehradun, 248002, India.
¹⁷ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India. ganeshbushi313@gmail.com.
¹⁸ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.

^# Contributed equally.

PMID: 40208448
DOI: 10.1007/s11255-025-04507-0

Review

Prevalence of BK virus and BK virus-associated hemorrhagic cystitis in stem cell transplant recipients: a systematic review and meta-analysis

Ambanna Yappalparvi et al. Int Urol Nephrol. 2025.

. 2025 Apr 10.

doi: 10.1007/s11255-025-04507-0. Online ahead of print.

Authors

Affiliations

¹ Centre Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University,, Rajpura, India.
² Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
³ University Center for Research and Development, Chandigarh University, Mohali, Punjab, 140413, India.
⁴ Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001, Hillah, Babil, Iraq.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India.
⁶ Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India.
⁷ Institute of Pediatric Gastroenterology and Hepatology, NIMS University, Jaipur, India.
⁸ School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University Dehradun, Dehradun, India.
⁹ Department of Pharmaceutics, Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, Uttarakhand, 248007, India.
¹⁰ Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India.
¹¹ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
¹² Department of Veterinary Microbiology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, Rampura Phul, Bathinda, Punjab, 151103, India.
¹³ Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁴ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, 411018, India.
¹⁵ SR Sanjeevani Hospital, Kalyanpur, Siraha, 56517, Nepal.
¹⁶ Computer Science and Engineering, Graphic Era (Deemed to Be University), Clement Town, Dehradun, 248002, India.
¹⁷ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India. ganeshbushi313@gmail.com.
¹⁸ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.

^# Contributed equally.

PMID: 40208448
DOI: 10.1007/s11255-025-04507-0

Abstract

Background: The BK virus (BKV) commonly affects stem cell transplant (SCT) patients and can lead to hemorrhagic cystitis (HC), a serious condition that negatively impacts patient health. This study reviews the frequency of BKV infections in SCT patients, particularly those who develop HC.

Methods: We searched Web of Science, PubMed, and Embase up to August 10, 2024, to identify relevant articles focusing on the prevalence of BKV-related hemorrhagic cystitis (HC) in stem cell transplant (SCT) patients. Two reviewers independently screened and extracted data using Nested Knowledge software. A meta-analysis of pooled prevalence rates was conducted using random-effects models in R software, version 4.4. Study heterogeneity was assessed with the I² statistic, and study quality was evaluated using a modified Newcastle-Ottawa Scale (NOS). Trim-and-fill funnel plot and Eggers test were used to assess publication bias.

Results: Of the 2700 articles identified, 15 met our inclusion criteria, encompassing 7856 participants. The overall pooled prevalence of BKV-related hemorrhagic cystitis (HC) was 12.8% (95% CI 8.7-18.5%), with rates varying significantly from 5.0 to 45.9%. This variation reflects differences in patient backgrounds, transplant methods, and diagnostic approaches (I² = 97%). The prevalence of BKV infections without HC was 45.8% (95% CI 14.0-81.4%), also showing wide variation from 0.8 to 94.7% and high heterogeneity (I² = 99%).

Conclusions: Our study identified a substantial prevalence of BKV-associated hemorrhagic cystitis in stem cell transplant patients, highlighting the importance of vigilant monitoring and effective treatment strategies to manage this risk. Enhancing both diagnostic techniques and treatment approaches is crucial for improving patient outcomes.

Keywords: BK virus; Hemorrhagic cystitis; Meta-analysis; Stem cell transplantation; Systematic review.

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Conflict of interest statement

Declarations. Conflict of interest: The authors report no conflict of interest. Ethical approval: This study is a systematic review and meta-analysis based on previously published studies; therefore, no new patient data were collected, and ethical approval was not required.

References

1. Kaur D (2018) Thrombotic and hemorrhagic complications in recipients of hematopoietic stem cell transplant: college of medicine-mayo clinic. Thrombosis Res 167(44):49
1. Ambalathingal GR, Francis RS, Smyth MJ, Smith C, Khanna R (2017) BK polyomavirus: clinical aspects, immune regulation, and emerging therapies. Clin Microbiol Rev 30(2):503–528 - DOI - PubMed - PMC
1. Dharnidharka VR, Abdulnour HA, Araya CE (2011) The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 26:1763–1774 - DOI - PubMed
1. Karagun BS, Aygunes U, Eken A, Akbas T, Melek E, Antmen B. (2021) Risk assessment for BK virus-associated hemorrhagic cystitis after pediatric hematopoietic stem cell transplant: a single-center retrospective cross-sectional study. Exp Clin Transplant. 17
1. Lanfranco OA, Alangaden GJ (2016) Genitourinary tract infections. Diagnostic microbiology of the immunocompromised host, Washington. https://doi.org/10.1128/9781555819040.ch22 - DOI

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[1] Kaur D (2018) Thrombotic and hemorrhagic complications in recipients of hematopoietic stem cell transplant: college of medicine-mayo clinic. Thrombosis Res 167(44):49

[2] Kaur D (2018) Thrombotic and hemorrhagic complications in recipients of hematopoietic stem cell transplant: college of medicine-mayo clinic. Thrombosis Res 167(44):49

[3] Ambalathingal GR, Francis RS, Smyth MJ, Smith C, Khanna R (2017) BK polyomavirus: clinical aspects, immune regulation, and emerging therapies. Clin Microbiol Rev 30(2):503–528 - DOI - PubMed - PMC

[4] Ambalathingal GR, Francis RS, Smyth MJ, Smith C, Khanna R (2017) BK polyomavirus: clinical aspects, immune regulation, and emerging therapies. Clin Microbiol Rev 30(2):503–528 - DOI - PubMed - PMC

[5] Dharnidharka VR, Abdulnour HA, Araya CE (2011) The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 26:1763–1774 - DOI - PubMed

[6] Dharnidharka VR, Abdulnour HA, Araya CE (2011) The BK virus in renal transplant recipients—review of pathogenesis, diagnosis, and treatment. Pediatr Nephrol 26:1763–1774 - DOI - PubMed

[7] Karagun BS, Aygunes U, Eken A, Akbas T, Melek E, Antmen B. (2021) Risk assessment for BK virus-associated hemorrhagic cystitis after pediatric hematopoietic stem cell transplant: a single-center retrospective cross-sectional study. Exp Clin Transplant. 17

[8] Karagun BS, Aygunes U, Eken A, Akbas T, Melek E, Antmen B. (2021) Risk assessment for BK virus-associated hemorrhagic cystitis after pediatric hematopoietic stem cell transplant: a single-center retrospective cross-sectional study. Exp Clin Transplant. 17

[9] Lanfranco OA, Alangaden GJ (2016) Genitourinary tract infections. Diagnostic microbiology of the immunocompromised host, Washington. https://doi.org/10.1128/9781555819040.ch22 - DOI

[10] Lanfranco OA, Alangaden GJ (2016) Genitourinary tract infections. Diagnostic microbiology of the immunocompromised host, Washington. https://doi.org/10.1128/9781555819040.ch22 - DOI

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Prevalence of BK virus and BK virus-associated hemorrhagic cystitis in stem cell transplant recipients: a systematic review and meta-analysis

Affiliations

Prevalence of BK virus and BK virus-associated hemorrhagic cystitis in stem cell transplant recipients: a systematic review and meta-analysis

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