EDITORIAL STAFF EDITORIAL BOARD Rafał Krenke, MD, PhD Warsaw, Poland EXECUTIVE EDITOR Franciszek Kokot, MD, PhD Eugeniusz J. Kucharz, MD, PhD Grzegorz Gajos, MD, PhD Katowice, Poland (Co-Chair) Katowice, Poland Roman Jaeschke, MD, MSc STATISTICAL CONSULTANT Jan Kulpa, MD, PhD Hamilton, ON, Canada (Co-Chair) Agnieszka Pac, PhD Kraków, Poland Małgorzata Bała, MD, PhD Jolanta Małyszko, MD, PhD MANAGING EDITOR Kraków, Poland Białystok, Poland Maria Piasecka, PhD MD, PhD Tomasz Brzozowski, Jacek Musiał, MD, PhD MANUSCRIPT EDITING Kraków, Poland Kraków, Poland Małgorzata Kurowska Flavio Coceani, MD Paul O'Byrne, MD, PhD Małgorzata Wiesner-Spyrczyńska Pisa, Italy Hamilton, ON, Canada Deborah Cook, MD, PhD SOCIAL MEDIA EDITOR Grzegorz Opolski, MD, PhD Hamilton, ON, Canada Zbigniew Heleniak, MD, PhD Warsaw, Poland Mark Crowther, MD, MSc, FRCPC Ralf Paschke, MD, PhD DTP Hamilton, ON, Canada Calgary, Canada Tomasz Śmigla Stanisław Czekalski, MD, PhD Marek Sanak, MD, PhD ADDRESS Poznań, Poland Kraków, Poland Cholerzyn 445 Anna Członkowska, MD, PhD Holger Schünemann, MD, PhD 32-060 Liszki, Poland Warsaw, Poland Hamilton, ON, Canada phone: +48 12 293 42 20 fax: +48 12 293 40 10 James Douketis, MD, FRCPC Tomasz Stompór, MD, PhD email: [email protected] Hamilton, ON, Canada Olsztyn, Poland www.mp.pl/paim Józef Drzewoski, MD, PhD Krzysztof Strojek, MD, PhD Łódź, Poland Copyright by Medycyna Praktyczna, Katowice, Poland Kraków 2019 Artur Dziewierz, MD, PhD Michał Tendera, MD, PhD Kraków, Poland Katowice, Poland PUBLISHER Piotr Głuszko, MD, PhD Medycyna Praktyczna Anetta Undas, MD, PhD Warsaw, Poland Kraków, Poland INDEXED IN Gordon Guyatt, MD, PhD Jadwiga Wedzicha, MD, PhD Chemical Abstracts Service (CAS), Hamilton, ON, Canada London, UK Crossref, Database of Abstracts of Andrzej Januszewicz, MD, PhD Reviews of Effects (DARE), EBSCO, Albert W. Wu, MD, PhD Warsaw, Poland EMBASE, GENAMICS, Geneva Baltimore, USA Foundation Free Medical Journals, Barbara Jarząb, MD, PhD Krystyna Zawilska, MD, PhD Index Copernicus (IC), J-Gate, Master Gliwice, Poland Poznań, Poland Journal List, MNiSW, National Library Wiesław W. Jędrzejczak, MD, PhD Irena Zimmermann-Górska, MD, PhD of Medicine (NLM), Polish Medical Warsaw, Poland Poznań, Poland Library (GBL), PubMed/MEDLINE, Irina Kowalska, MD, PhD Science Citation Index Expanded (SCI-Ex), Dorota Zozulińska-Ziółkiewicz, MD, PhD Białystok, Poland SciFinder, Scopus, TUMS Digital Library, Poznań, Poland Web of Science Core Collection Print ISSN: 0032-3772 Online ISSN: 1897-9483 Impact Factor 2018 = 2.882 OPEN ACCESS This is an Open Access publication distributed under the terms of the Creative Commons The journal receives funding from Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties the Ministry of Science and Higher Education to copy and redistribute the material in any medium or format and to remix, transform, and build upon for promoting scientific research the material, provided the original work is properly cited, distributed under the same license, and used for (agreement no. 595/P-DUN/2019). noncommercial purposes only. 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Powyższe ceny obowiązują wyłącznie na terenie Polski. INFORMACJE DODATKOWE Prenumeratorzy czasopism Wydawnictwa mają prawo do zniżki przy zakupie jednego egzemplarza każdej książki i wydania specjalnego. Na naklejce adresowej znajdują się informacje dotyczące: • zawartości przesyłki • kwoty informującej o ewentualnej nadpłacie lub niedopłacie w stosunku do zamówienia • ostatniego opłaconego lub zamówionego numeru każdego z czasopism KONTAKT • telefoniczny (pn.–pt., 8.00–18.00) pod numerami: 800 888 000 (z telefonów stacjonarnych, bezpłatna infolinia) 12 293 40 80 (z telefonów komórkowych i stacjonarnych) • pocztą elektroniczną ([email protected]) An official journal of the Polish Society of Internal Medicine founded by professor Władysław Antoni Gluziński MONTHLY VOL. 129 (SPECIAL IssUE 3) 2019 ABSTRACT PART I GENERAL OVERVIEW OF MAJOR VIRAL INFECTIONS 7 Cytomegalovirus 10 BK virus 14 Epstein–Barr virus 15 Influenza 16 Hepatitis C virus 17 HIV 21 Human papilloma virus PART II SPECIFIC ISSUES IN MANAGEMENT OF VIRAL INFECTIONS IN TRANSPLANT RECIPIENTS 23 Viruses versus myocarditis and acute coronary syndromes 24 Viruses and kidney transplant eligibility 25 Treatment of hepatitis B virus infection in transplant recipients 27 Viral infections in kidney and upper extremity transplant recipients 28 Histological diagnosis of BK virus and cytomegalovirus infections 29 Viral diarrhea 29 Ground glass opacification PART III COMMENTARY 35 The art of immunosuppression in liver transplantation: personal reflections based on a 40-year career ABSTRACT The 3 leading causes of death in patients after sol‑ Immunosuppressive treatment impairs the im‑ id organ transplantation (SOT) include cardiovas‑ mune function, which renders the patient more cular diseases, malignancies, and infections. Ac‑ susceptible to infections. Furthermore, treat‑ cording to our current understanding, the latter ment of infections in immunocompromised pa‑ play the key role in the pathogenesis of athero‑ tients poses a challenge and SOT. sclerosis. Similarly, infections (mainly viral) are The current publication provides a brief summa‑ implicated in the pathogenesis of at least 20% of ry of the key information provided in 20 lectures known neoplasms. In other words, the implica‑ on viral infections in patients after SOT delivered tions of acute and chronic infectious diseases in during the 9th Practical Transplantology Course in modern medicine, not only transplantology, are Warsaw, Poland on September 15–16, 2017. significant and ever ‑increasing. PART I General overview of major viral infections Krzysztof Mucha1,2*, Bartosz Foroncewicz1*, Alicja Dębska ‑Ślizień3, Magdalena Durlik4, Ryszard Grenda5, Andrzej Horban6, Piotr Fiedor7, Magdalena Krajewska8, Artur Kwiatkowski7, Jan Lerut1,9, Jacek Małyszko10, Jolanta Małyszko11,12, Piotr Przybyłowski13,14, Krzysztof Zieniewicz15, Michał Ciszek1, Dorota Kamińska9, Maciej Kosieradzki8, Agnieszka Perkowska ‑Ptasińska5, Justyna Czerniawska16, Dominika Dęborska5, Radosław Kwieciński14, Magdalena Kwapisz8, Barbara Moszczuk1, Leszek Pączek1,2 1 Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland 2 Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland 3 Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Poland 4 Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Poland 5 Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland 6 Department for Adult’s Infectious Diseases, Medical University of Warsaw, Poland 7 Department of General and Transplantation Surgery, Medical University of Warsaw, Poland 8 Chair and Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland 9 Starzl Unit Abdominal Transplantation, University Hospitals Saint Luc, Université Catholique de Louvain, Brussels, Belgium 10 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University of Białystok, Białystok, Poland 11 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Białystok, Poland 12 Department of Nephrology, Dialysis and Internal Diseases, Medical University of Warsaw, Warsaw, Poland 13 1st Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland 14 Silesian Center for Heart Diseases, Zabrze, Poland 15 Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland 16 Department of Radiology, Medical University of Warsaw, Poland Cytomegalovirus infection Immune response to cy- termed “a 40­­‑day fever”, due to an increase of tomegalovirus in solid organ transplant recipient Cy‑ body temperature with the onset on day 40 fol‑ tomegalovirus (CMV) is one of the most common lowing transplantation, present in most cases. opportunistic pathogens in individuals with pri‑ Depending on the transplanted organ, CMV in‑ mary or secondary immunodeficiency, such as fection may present as: a) bronchiolitis obliter‑ organ transplant recipients. Prior to the intro‑ ans syndrome or interstitial pneumonia, some‑ duction of ganciclovir (GCV), which is common‑ times leading to respiratory