On the Cover: Neutrophil extracellular traps (NETs) are known to be active in the innate immune response to pulmonary bacteria. However, they are inherently cytolytic and, as such, can cause bystander injury to the delicate structures in the lung. DNAse treatment is now used in several pulmonary inflammatory diseases to limit this injury. In this issue of AJT, Scozzi et al (page 1011), through elegant experiments in mice, demonstrate that NET fragments generated by DNAse treatment trigger toll-like receptor signaling in antigen-presenting cells that enhance alloimmunity and inhibit immunosuppression-mediated lung transplant tolerance. This study underscores the interplay between innate and acquired immunity and highlights new mechanisms for alloimmune activation in the lung. Also in this issue, Becker and Nissenson (page 995) introduce their Viewpoint on the Dialysis PATIENTS Demonstration Act, countered by a thoughtful editorial by Gill and Wiseman (page 973) providing their thoughts on the implications of this legislation for transplantation. Cover design by Megan Llewellyn, Duke University Department of Surgery.

This month's installment of “The AJT Report” explores the potential effects of a new quality metric proposed by the Centers for Medicare & Medicaid Services that is designed to boost transplant access for dialysis patients. We also report on the recent successful transplant of a hepatitis C–positive heart to the director of New York University Langone Health's Transplant Center.

By using mice with alterations in mitochondrial complex III in Tregs, the authors of the featured manuscript demonstrate the essential role of mitochondrial respiration for Treg suppressor function and for the prevention of lymphoproliferation and autoimmunity.

The authors express concern that recent FDA rules will make common immunosuppressive protocols unavailable to Medicare lung transplant recipients.

This editorial presents concerns about efforts to advance an integrated dialysis care plan that does not prioritize prevention of kidney failure and transplantation for patients who develop end-stage kidney disease. Read Becker and Nissenson's viewpoint on page 995.

This article examines therapeutic donor hypothermia, dopamine donor pretreatment, and hypothermic pulsatile machine perfusion for the amelioration of early graft dysfunction after kidney transplantation on the basis of the most prominently published clinical trials in this field indicating that machine perfusion is less effective compared to the donor intervention strategies.

The authors summarize the proceedings of the American Society of Transplantation consensus conference on frailty in solid organ transplantation, an emerging concept with potential consequences for patient risk stratification and optimization that arises before and after transplant.

A simple preservation technique may recover lungs from uncontrolled donation after circulatory death with excellent long-term posttransplant outcomes.

This clinical cohort study indicates that a combination of hypo- and normothermic machine perfusion, using a preservation fluid containing an hemoglobin-based oxygen carrier, is feasible and provides a tool to resuscitate and select initially declined high-risk donor livers that can be transplanted successfully.

Surveys of attitudes around liver donation evaluated using conjoint analysis and clarifying follow-up questions identify differences between allocation rules and public preferences with respect to incorporating outcomes after transplant, prioritizing US citizens or residents, keeping organs local, and including cost in allocation decisions.

Results from a phase I study of adolescent renal transplant recipients administered a single intravenous infusion of belatacept at 7.5 mg/kg show comparable pharmacokinetic and pharmacodynamic values to those obtained historically from healthy adult volunteers given a single dose of belatacept (10 mg/kg) and adult kidney transplant recipients administered multiple doses of belatacept (5mg/kg/dose).

Exemplifying the dangers of transplant tourism, a patient who traveled to Pakistan for a commercial kidney transplant developed a life-threatening infection from New Delhi metallo-β-lactamase–1–producing Enterobacter cloacae.

The CDC provides an update on immunization practices for children and adolescents under 18 years old.

This report updates the immunization practices for adults 19 years old and older.