American Journal of Transplantation: Volume 19, Number 4, April 2019

On the Cover: Neutrophil extracellular traps (NETs) are known to be active in the innate immune response to pulmonary bacteria. However, they are inherently cytolytic and, as such, can cause bystander injury to the delicate structures in the lung. DNAse treatment is now used in several pulmonary inflammatory diseases to limit this injury. In this issue of AJT, Scozzi et al (page 1011), through elegant experiments in mice, demonstrate that NET fragments generated by DNAse treatment trigger toll-like receptor signaling in antigen-presenting cells that enhance alloimmunity and inhibit immunosuppression-mediated lung transplant tolerance. This study underscores the interplay between innate and acquired immunity and highlights new mechanisms for alloimmune activation in the lung. Also in this issue, Becker and Nissenson (page 995) introduce their Viewpoint on the Dialysis PATIENTS Demonstration Act, countered by a thoughtful editorial by Gill and Wiseman (page 973) providing their thoughts on the implications of this legislation for transplantation. Cover design by Megan Llewellyn, Duke University Department of Surgery.