On the cover this month: Donor safety is arguably the most critical consideration in organ transplantation. While live donor kidney transplantation has advanced based on the premise that healthy donors are not disadvantaged with regard to long-term mortality, this assumption has not been specifically examined as it relates to older donors, and this is increasingly relevant as the population in general ages. This month, Reese et al (page 1853) examine the long-term survival of donors over the age of 55 and show that long-term mortality is not adversely affected. This provides direct evidence as to the relative safety of kidney donation for healthy older patients and validates current restrictive practices limiting donation to patients without significant comorbidities. Also, see the online version of the Iyer et al article (page 1744) on DCD heart protection for two accompanying videos. Cover design by Michael Konomos.

Experts in transplantation and related medical fields have a common goal of increasing organ donation in the United States by 1,000 transplants per year for the next five years. This issue of “The AJT Report” looks at how this committee came together, and what the goal will mean for the field. Also this month, we review how a policy interpretation from CMS is impacting offsite organ recovery.

Understanding the immunoregulatory roles of mTOR complexes in transplantation may prove valuable in the design of novel therapeutic strategies.

This editorial offers a counterpoint to the findings of increased mortality in living kidney donors in a study by Mjøen et al that has been widely discussed in the transplant community.

The results of the multicenter belatacept liver transplant trial disappoint with respect to safety and efficacy, and new approaches will be required before this agent plays a role in liver transplant immunosuppression. See article by Klintmalm et al on page 1817.

This editorial approves the use of everolimus to wean calcineurin inhibitors (by 7–11 weeks postoperative) as safe and effective with improved first-year renal function and reduced intimal thickness by intravascular ultrasound. See article by Andreassen et al on page 1828.

This editorial puts into perspective the findings of the first randomized, controlled trial examining alemtuzumab induction for lung transplantation, and highlights the challenges encountered with alemtuzumab induction in other solid organs. See article by Jaksch et al on page 1839.

This review discusses large national datasets that have been used to address research questions in organ transplantation, with a description of available datasets and consideration of proper study design.

The process of autophagy was originally described in cells under starvation, but numerous studies now establish the link with most cellular stress-response pathways, including those involved in controlling immune response and inflammation.

This viewpoint supports increased transparency of national practices by reviewing the first 22 months of data collected regarding noncitizens and nonresidents who traveled to the United States for purposes of transplantation.

Crossmatch analysis of human antibody binding to cells from pigs genetically modified for xenotransplantation is similar to allogeneic cells, lower than chimpanzee cells, and unaffected by age, gender, or blood type.

A retrospective cohort study of Clostridium difficile infection in 970 liver transplant recipients finds high prevalence (18.9%), recurrence (16.9%), and relapse (9.7%) rates, and significantly higher all-cause mortality.

A survey of 29 centers participating in the North American Studies in Pediatric Liver Transplantation reveals that prophylaxis predominates cytomegalovirus prevention strategies, although the duration of prophylaxis ranges broadly, providing the opportunity for comparative effectiveness evaluation to assess optimal duration of prophylaxis in this indication.

This gene expression profiling substudy of BENEFIT and BENEFIT-EXT identifies gene sets differentially expressed at 12 months posttransplant in kidney biopsies of belatacept- versus cyclosporine-treated patients and provides mechanistic insights into the reduced chronic allograft injury and improved renal function observed with belatacept treatment.

The estimated posttransplant survival score, which will be used to prioritize allocation of the best 20% of deceased donor kidneys in the United States, is moderately good at discriminating posttransplant survival of adult kidney-only transplant recipients, even in an external dataset with differing donor, recipient, and allocation system characteristics.

The authors describe the insertion of a novel extra-anatomic stent in a 65-year-old male renal transplant patient in whom all conventional methods of treatment (endo-urological and surgical) failed to bypass a complete ureteric obstruction.

The authors report a successful laparoscopic kidney transplant performed by an extra-peritoneal approach.

Measles is on the rise in the United States, posing a potential hazard for unvaccinated transplant recipients.