On the cover this month: Substantial progress has been made in the last 5 years in bioengineering and regenerative medicine. This month, Taylor et al (page 2448) provide an update on the remarkable advances in cardiac construction, and the role this emerging option may play in the future of multimodal therapy for patients with heart failure. Also see our Images in Transplantation section on page 2664 for the opportunity to earn CME credit. Cover design by Ken North, North Design Group.

In this edition of “The AJT Report,” we review a new international treaty that will enact legislation to consistently and harshly punish participants of organ trafficking. Also this month, we talk to David Klassen, the first-ever chief medical officer for UNOS, about his goals for his new role.

New data on the ligand-dependent internalization of CTLA-4 offers fresh insight into its mechanism of action and suggests that this property could be exploited as a novel method of drug delivery.

This editorial provides commentary on Hongo et al's (page 2467) demonstration that transplant tolerance induction after recipient conditioning with total lymphoid irradiation, antithymocyte serum, and donor bone marrow transplantation requires arginase-1–expressing myeloid-derived suppressor cells that are generated in response to invariant natural killer T cell interleukin-4 production.

The authors discuss the clinical utility of the Kidney Donor Profile Index and pretransplant kidney biopsy in selection of marginal kidney donors, and why neither should be used alone for making a decision on organ acceptance or rejection. See article by Gandolfini et al on page 2515.

This commentary discusses the benefits and limitations of cinacalcet use for posttransplant hypercalcemia and secondary hyperparathyroidism, alternative management options, and gaps in our evidence base. See article by Evenepoel et al on page 2545.

This review discusses some of the factors that should be considered in the development of tissue-engineered products, and it describes the methods currently being investigated to generate more effective heart valves, cardiac patches, and whole hearts.

The authors provide an overview of the circumstances leading to loss of the critical T cell costimulatory molecule CD28, and they discuss the transplant-relevant consequences of this sign of progressive T cell maturation.

The high-sensitive troponin T, an established marker of cardiovascular risk, and quantitative myocardial perfusion reserve during vasodilator cardiac magnetic resonance exhibit complementary value for the prediction of chronic allograft vasculopathy progression and clinical outcomes in cardiac transplant recipients.

This study demonstrates that the proportion of naturally occurring regulatory T cells, identified by a specific demethylated region in the forkhead box P3 locus, is associated with increased cutaneous squamous cell carcinoma in kidney transplant recipients and is a useful biomarker of cancer risk.

The authors report on nine patients with recurrent 2,8-dihydroxyadenine nephropathy following renal transplantation, pointing to adenine phosphoribosyltransferase deficiency as a rare but significant cause of renal allograft dysfunction.

This manuscript describes two cases of donor-derived methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, confirmed through comparison of S. aureus whole genome sequence of DNA extracted from fixed donor tissue and recipients' isolates, that developed after transplantation of organs from a common donor who died from acute MRSA endocarditis. Also see case report by Altman et al on page 2640.

This report describes a successful outcome in a liver transplant recipient after deceased donor transmission of methicillin-resistant Staphylococcus aureus confirmed by whole genome sequencing. Also see case report by Wendt et al on page 2633.

The authors describe two cases of parvovirus B19–associated fulminant hepatic failure and aplastic anemia managed with sequential liver and bone marrow transplantation and excellent long-term outcome.

The authors present a case of graft-versus-host disease after simultaneous pancreas–kidney transplantation, including its clinical manifestations, use of cytogenetic techniques for diagnosis and monitoring, and successful treatment with high-dose steroids, high tacrolimus levels, and extracorporeal photopheresis.

The authors describe two cases of pancreas transplant recipients whose calcineurin inhibitor maintenance regimen was converted to belatacept to avoid chronic kidney disease progression, which allowed these patients to be maintained pancreas rejection–free on belatacept therapy, while maintaining excellent renal function.

This report details an increase in cases of enterovirus D68, a cause of severe respiratory illness most commonly found in children, and one that should be considered as potentially problematic in donors or recipients.