Abstract Objectives This study aims to study the clinical features, pathological findings, and outcomes of BK virus‐associated urothelial carcinoma (UC) in kidney transplant recipients (KTRs). Patients and Methods The study was conducted in a retrospective cohort of KTRs with histologically confirmed UC managed at a UK supra‐regional transplant urology centre from November 2006 to January 2026. BK virus status was determined using polymerase chain reaction (PCR) testing, and tumour samples were assessed for SV40 large T antigen. Patients were stratified by BKV and SV40 status to enable comparison of tumour grade, stage, and other clinicopathological features. Results 24 KTRs met the inclusion criteria; 11 of whom were BKV+. The mean follow‐up time post‐UC diagnosis was 7.3 6.1 years. Mean age at UC diagnosis was 59.9 14.6 years. 90.9% of BKV+ patients had high‐risk UC compared to 30.8% of the BKV− group ( p = 0.005). Tumour grade at diagnosis was higher in BKV+ patients ( p = 0.013). SV40 Large T antigen was detected in 33.3% of cases, all with a previous history of BKV infection. These tumours were all high grade (G3) and had tended to be a higher stage at diagnosis than SV40− tumours ( p = 0.050). UC in BKV+ patients was not diagnosed earlier post‐transplant ( p = 0.616). There was no difference in survival probability between the two cohorts ( p = 0.639). Conclusion BKV infection in KTRs was associated with aggressive, high‐grade UC. Screening and timely adjustment of immunosuppression are essential to protect this at‐risk population. Further studies are required to clarify the oncogenic potential of BKV and optimise management strategies.
Beetge et al. (Sun,) studied this question.
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