On the cover this month: Transplantation has always been viewed as a multispecialty discipline, dependent on the aggregate actions of many diverse professionals. As healthcare reform moves us to more explicitly value the actions involved in care delivery, transplant clinicians will need to determine how best to establish compensation methods that recognize the complexity of the profession. This month, Abouljoud et al (page 601) present a novel model for establishing value for the purpose of setting compensation. Also see the editorial comment by Abecassis and Pearson (page 579) and a related brief communication on transplant surgeon burnout by Jesse et al (page 772). Cover design by Ken North, North Design Group.

Despite movement in the United States toward cost-saving bundled payments to physicians, the Centers for Medicare and Medicaid Services issued a final rule for the 2 015 Medicare Physician Fee Schedule that unbundles 10- and 90-day global payments, and that allows only zero-day payment for surgical services. This month, “The AJT Report” talks to transplant surgeons about what the new paymen t provisions mean for their practices. Also in this issue, we take a look at China's recent announcement that it has ceased the use of organs from executed prisoners effective this year, a policy met with both support and skepticism from the transplant community.

New data reveal phenotypic differences in self-renewing vs. antibody-producing memory B cells.

Physician productivity and compensation face a paradox in the era of fee-for-value care delivery. See personal viewpoint by Abouljoud et al on page 601.

Although the initial experience with Share 35 liver allocation has enhanced regional sharing for sick liver transplant candidates while increasing organ utilization and national transplant volume, potential costs with regard to system efficiency and the impact on mid- to long-term posttransplant outcomes remain to be delineated. See article by Massie et al on page 659.

The results achieved in the Stanford trial (Scandling et al, page 695), if confirmed, suggest that our community should reconsider long-held views on the adjunctive role of donor hematopoietic transplant–based strategies in clinical organ transplantation.

This study reviews the clinical impact of rotavirus infection in the setting of organ transplantation and disseminates the interactions among the virus, host, and immunosuppressive medications.

The author defines the role of mast cells in lung transplantation and proposes mechanisms by which mast cells adapt to the immunological environment with the potential to improve transplant outcome.

Healthcare reform and transplant center alignment require a comprehensive new approach to transplant physician and surgeon compensation. See editorial by Abecassis and Pearson on page 579, as well as a related brief communication by Jesse et al on page 772.

This cross-sectional study of American transplant surgeons shows elevated emotional exhaustion but low levels of depersonalization and personal accomplishment, and discusses factors that contribute to each. See related personal viewpoint by Abouljoud et al on page 601.

In this pilot trial of calcineurin-inhibitor withdrawal in pediatric liver transplant recipients, complete discontinuation of immunosuppression improves glomerular filtration rate but not metabolic syndrome or its components, which are more prevalent than expected for age and obesity in both participants and historical controls.

This two-center retrospective study shows an unexpected high mortality rate and wide range of complications occurring in 12 patients suffering from propionic acidemia who underwent liver transplantation over the last 20 years.

Staphylococcus aureus respiratory isolation in concert with elevated bronchoalveolar lavage CXCL5 concentrations augments the risk of bronchiolitis obliterans due to their state-specific effects after lung transplantation, while pseudomonas and elevated concentrations of CXCL5 continue as significant risk factors for both bronchiolitis obliterans and death after bronchiolitis obliterans.

This study demonstrates that kidney transplant recipients who carry the CYP3A4*22 allelic variant and are low expressors of the cytochrome P450 3A4 in the liver have an increased risk of tacrolimus overexposure and need doses that are 30% lower than individuals who express the cytochrome P450 3A4.

This single-center prospective study of kidney transplant recipients shows that patients with detectable anti-HLA antibodies display lower proportions of NK cells and increased CD56bright and NKG2A⁺ subsets than patients without antibodies, the latter being more marked in cases with donor-specific antibodies.

The authors demonstrate in a depletion-based nonhuman primate renal transplantation model that neutralizing BAFF/APRIL with atacicept decreases donor-specific antibodies and B cell numbers during active treatment, thus diminishing the overall humoral response after transplantation.

This case describes the need for early recognition of posterior reversible encephalopathy syndrome in a heart transplant recipient, and the importance of supportive therapy and withdrawal of causative factors.

Adoptive T cell immunotherapy using cytomegalovirus-specific T cells from a donor bank is used as salvage therapy in a case of ganciclovir-resistant cytomegalovirus disease in a renal transplant recipient.

The authors describe their experience of one heart recipient and two kidney recipients with fatal scedosporiosis following deceased donor transplantation from the same donor, a nearly drowned victim of a suicide attempt.

Occupationally acquired HIV has been rarely reported in health care workers, and there have been no cases reported since 2008, possibly related to improved treatment/prevention strategies and technological advances.