On the cover this month: The advent of direct-acting antiviral agents with efficacy for HCV provides numerous new options for the treatment of HCV in recipients, regardless of organ. These treatment strategies are changing the calculus for clinicians who must weigh the odds of HCV disease progression (or acquisition) versus the utility of reducing wait time by accepting an HCV-positive organ. This month, AJT covers this topic in depth, presenting numerous original articles, editorials, and reviews evaluating the impact of pre–, peri–, and post–transplant use of direct-acting HCV-specific antiviral therapies. Cover design by Megan Llewellyn, Duke University Department of Surgery.

This month's installment of “The AJT Report” looks at how transplanting HCV-positive organs can reduce risks for patients awaiting organs. We also report on Bristol Myers Squibb's recent easement of restrictions in prescribing belatacept (Nulojix).

Extracellular ATP promotes durable CD8+ T cell memory by signaling through the purinergic receptor P2RX7.

Sawinski reviews two Markov decision analyses for timing of HCV therapy and expanded use of HCV-positive kidneys, as well as the real-world transplant consequences of HCV treatment in transplant candidates. See the companion articles on pages 2443, 2457, and 2559.

In this editorial, the authors highlight recent work from de Vera et al (page 2451) regarding the transplantation of kidneys from HCV antibody–positive donors to HCV-negative recipients that should increase provider confidence in the safety of using these organs.

HCV therapy is highly effective but underutilized in the transplant setting, likely due to a combination of insurance barriers and lack of adherence to treatment guidelines by transplant professionals. See the article from Axelrod et al on page 2473.

This review describes the problems associated with the transplantation of steatotic donor livers and discusses pharmacological and nonpharmacological options that are being developed to enhance metabolic recovery using ex situ machine perfusion and defatting strategies.

Normothermic machine perfusion of kidneys, an upcoming method for reconditioning and repair, has the potential to serve as a platform for pretransplant allograft modulation in which various therapies can be introduced to alleviate ischemia-reperfusion injury.

This article considers the optimal use of direct-acting antiviral agents for patients with HCV pre–, peri–, and post–liver transplant and provides expert opinion on current controversies and clinical issues that remain to be addressed.

In a multicenter study, deferring HCV treatment in viremic patients until after kidney transplant compared to pretransplant treatment results in increased access to transplant and shortened waitlist time with 100% HCV treatment response and with no negative consequences to the allograft. See the companion articles on page 2443 and 2457, and an editorial on page 2377.

Hepatic encephalopathy plays an important role in the frailty phenotype and the prognostic implications of frailty among patients with cirrhosis evaluated for liver transplantation.

Long-term follow-up of heart transplant patients reveals an association between rejection rates and high first-year variability of tacrolimus levels.

Following the HOPE Act, organs from donors with false-positive HIV tests are recognized as a novel resource that could help HIV-infected individuals in need of organ transplants in the United States.

The authors describe a case of HCV late relapse occurring 93 weeks after direct-acting antibody treatment and immediately after liver transplantation with HCV NS5A sequencing performed on samples before and after transplant with 99% of homology demonstrating a true late relapse.

Graft-versus-host disease of the central nervous system following liver transplantation is a rare complication that can be diagnosed by short tandem repeat analysis of the cerebrospinal fluid, but is often life-threatening, in keeping with the overall poor prognosis of this disease.

Approximately 10.5% of the 257 million people living with hepatitis B are aware of their infection and only 1 in 6 of those aware of their infection are receiving treatment, potentially creating a large pool of individuals at risk for end-stage liver disease and hepatocellular cancer.