This month, we take an in-depth look at Arizona's decision to deny coverage for certain transplants, and hear responses to the controversial legislation from leaders in the field of transplantation.

Members of the Predictive Safety Testing Consortium undertook a comprehensive preclinical study of renal toxins to develop more sensitive and specific biomarkers of renal function and injury. The results are illuminating and point the way to alternative measures of renal injury and function.

The best available data support the view that organized staffing of intensive care units, under the direction of intensivists, improves outcomes for critically ill patients. See special article by Ranjan et al on page 670.

This editorial discusses the natural history of IF/TA, with specific reference to the progress of immunosuppressive regimens and input of molecular phenotyping. See articles by Stegall et al (page 698) and Mengel et al (page 708).

The implementation of calculated PRA has been a success and is changing clinical practice; however, the concept is not new and there remains room for improvement. See article by Cecka et al on page 719.

While observational studies are important in transplantation, inferences from nonrandomized trials that seem contrary to putative biological mechanisms must be made with great care. See article by Molnar et al on page 725.

The authors review recent findings concerning the at times paradoxical effects of mTOR inhibition through rapamycin on CD4+ and CD8+ T cell responses in transplantation and protective immunity.

This review discusses the innate immune interplay between complement and Toll-like receptor activation in relation to pretransplant renal injury by donor brain death and early posttransplant renal ischemia-reperfusion injury.

The ASTS takes a stand that the current move towards “closed” ICUs is unwarranted and may be detrimental in the care of transplant patients, and that many transplant surgeons function well in the role of intensivist for their patients. See editorial by Fink on page 645.

A multidisciplinary working group presents evidence-based recommendations for donor screening and follow-up testing and treatment of organ recipients from infected living and deceased donors with Chagas disease.

The authors report on an international meeting focusing on advances in immunology and biologics, jointly sponsored by AST and ESOT, held in Nice, France, in October 2010.

The author questions the significance of calcineurin inhibitors in posttransplant kidney dysfunction. See rhetorical viewpoint by Chapman on page 693.

Reviewing the data that lead to the conclusion that chronic CNI nephrotoxicity contributes to loss of kidneys in the long term, the author reviews data from the last 3 decades to understand the issues of today. See rhetorical viewpoint by Matas on page 687.

Donor passenger leukocytes exchange MHC molecules with the recipient, resulting in antigen presenting cells expressing both donor and recipient MHC; this includes recipient MHC molecules presenting donor derived allopeptides, thus providing a link between the direct and indirect antigen presentation pathways.

PDL1 expression on nonhematopoietic donor cells, particularly endothelium, plays an essential role in controlling the alloimmune response and in inducing tolerance in vascularized cardiac allografts.

Donor-directed MHC class I antibody is preferentially cleared, relative to class II antibody, in sensitized recipients of combined liver/kidney transplants.

All US organ procurement organizations responded to a survey describing their donor screening practices for Trypanosoma cruzi infection and organ utilization from seropositive donors.

The authors report a case in which a living related renal transplantation was performed as rescue treatment for therapy-resistant renovascular hypertension due to fibromuscular dysplasia.

This study describes the relation between the development of post–liver transplant portal vein thrombosis and ischemic-type biliary lesions, revealing portal vein thrombosis as a risk factor for developing ischemic-type biliary lesions.

As detailed in this report, stored vessels from donors with hepatitis may be a potential source of donor-derived hepatitis when used in transplant recipients.