I guess I should have disambiguated my usage of "persistent". In this case it refers to a purely-functional data structure[1], not a data structure that is persisted to disk. Inserting an item into a persistent B-tree produces a new tree, while leaving the old one intact. Ideally, this is done with minimal copying; unchanged subtrees are just pointers to the same subtrees in the old tree.
This is very similar to persistent hash tries, which are used by purely-functional languages like Haskell. But I designed this B-tree library as an implementation of SRFI 146, which uses a comparison function, not a hash function, to create a key-value mapping.
If you're interested in B-trees being persisted to disk, that's how most databases and most filesystems already work.
[1] https://www.geeksforgeeks.org/persistent-data-structures/