On the cover this month: Hepatitis C virus (HCV) remains one of the most common indications for liver transplantation and a significant problem for much of the chronic dialysis population. Importantly, although liver transplantation is an effective remedy for HCV-related liver failure, posttransplant HCV recurrence remains a near certainty. However, many new antiviral agents are emerging with legitimate promise to not only control HCV, but eliminate it. Gane and Agarwal (page 994) provide an update on the drugs that may potentially dethrone HCV as a top indication for transplantation. Also in this issue, Stock et al (page 1136) make novel observations regarding an association between sirolimus exposure and a lower frequency of CD4 lymphocytes containing HIV DNA, suggesting that immunosuppression required for kidney transplantation in the HIVinfected recipient may impact the level of HIV persistence. Cover design by Ken North, North Design Group.

Patients with heart failure are increasingly being implanted with mechanical circulatory support devices. “The AJT Report” takes a look at the history—and future—of their use, and how the heart allocation system may need to change to differentiate among the sickest patients. Also this month, we review results of a new study that concludes that smokers' lungs may be sufficiently suitable for transplant.

A recent publication identified a previously unappreciated form of PTEN, a tumor suppressor that is mutated in multiple cancers, with some surprising properties that suggest this protein can be transferred from one cell to another. The results offer the possibility of designing specific peptide-based drugs to target cells for immunosuppression or tolerance induction.

This editorial discusses the development of regulatory dendritic cell therapies in transplantation during the past two decades, and highlights the study by Segovia et al (page 1021) on the beneficial effect of administration of non-antigen-pulsed autologous dendritic cells in a mouse model of minor-mismatched skin transplantation.

Livers from donation after circulatory death offer additional access to life-saving transplant, but their effective use depends greatly on recipient disease burden and the geographic availability of livers from brain dead donors. See article by Allen et al on page 1120.

This article reviews direct-acting antiviral agents that improve the safety and efficacy of hepatitis C virus treatment before and after liver transplantation.

In response to the requirement for live kidney donor screening for Chagas disease, strongyloidiasis, and West Nile virus by the Organ Procurement and Transplantation Network, the Transplant Infectious Diseases Community of Practice provides specific testing guidelines. (Also see case report by Le et al on page 1199.)

This report provides a summary of the advances in transplant-related dermatology research and clinical medicine presented at the international biennial scientific retreat of the Skin Cancer Collaborative.

The authors contend that the current state of donation after circulatory determination of death liver transplantation will not advance without a focused initiative, and herein they present arguments to support this contention.

The authors report a B cell phenotype analysis in kidney transplant recipients who have stable renal function on belatacept maintenance immunosuppression, and show that belatacept influences the B cell compartment by favoring the occurrence of transitional B cells as described in operationally tolerant patients. (Also see article by Kirk et al on page 1142.)

The investigators examine for BK virus encoded microRNAs in the blood of renal transplant recipients and detect these microRNAs in patients with active BK virus nephropathy.

This randomized placebo-controlled trial of induction therapy in lung transplantation demonstrates that a single early posttransplant dose of ATG-Fresenius does not reduce acute cellular rejection, graft loss, or death within the first year of lung transplantation.

This case series of suspected donor-derived strongyloidiasis highlights the epidemiology of Strongyloides stercorals and draws attention to the importance of diligent screening in all at-risk recipients and donors, as well as high index of suspicion and timely notification of possible donor-derived infections. (Also see special article by Levi et al on page 1003.)

The authors report the development of iatrogenic Castleman's disease in an HIV-negative male 1 year post-liver transplantation who was treated successfully by reducing immunosuppression and administering rituximab.

The 2014 adult immunization guideline changes are highlighted in these recommendations.