On the Cover: The United States Congress has for decades failed to adopt a means of providing sustained immunosuppressive drug coverage for recipients of kidney transplants, despite objective evidence from the General Accounting Office that doing so would save taxpayer dollars and convincing data from the federal registry of transplant outcomes demonstrating that transplant outcomes would improve and American lives be saved. This month, Hart et al (page 1964) provide further evidence that kidney transplant graft loss is directly hastened by federal Medicare policy. Vanessa Grubbs provides a thoughtful commentary (page 1877) asking the salient question, “Why does Congress fail to pass Medicare immunosuppressant coverage laws that save grafts—and lives?” Cover design by Lauren Halligan, Duke University Department of Surgery.

This month's installment of “The AJT Report” discusses current, innovative efforts to increase health literacy among transplant patients to improve posttransplant results. We also report on a recent case of acquired food allergy via lung transplantation.

Select gut lymph node drainage is associated with tolerogenicity versus immunogenicity of intestinal antigens, a phenomenon that may be co-opted to promote tolerance or boost vaccination.

This commentary discusses a novel role of mitochondrial DAMPs in allograft rejection reported by Lin et al (page 1917).

This editorial calls into question why Congress fails to pass Medicare immunosuppressant coverage laws that save grafts—and lives. See the article from Hart et al on page 1964.

Thoughtful utilization of older donor livers may provide survival benefit for liver transplant candidates, and may be facilitated by changes to allocation policy, novel technologies for organ perfusion, and shifting regulatory scrutiny away from 1-year posttransplant survival. Haugen et al's findings are reported on page 2020.

This minireview examines functions of the scavenger receptor for IgG that could be leveraged to manipulate the half-life of therapeutic IgG biologics and pathogenic IgG antibodies in transplant recipients.

The AST/ASTS Transplant Metrics Taskforce examines the relevance of current program-specific reporting for kidney transplantation in the modern era.

This summary statement about frailty in liver transplantation addresses how to define and measure frailty, and how to incorporate frailty into the care of patients with end-stage liver disease, including those awaiting liver transplantation.

The authors examine the drivers of geographic disparity in liver transplantation, with a critical analysis of the utility of donor service area and state of residence in patient listing patterns. See a counterpoint from Samstein and McElroy on page 1912.

The authors respond to Lynch et al (page 1907) and argue that competition through increased sharing is good, changes to allocation policy should enhance transparency, and innovative approaches that increase demand for all organs should be encouraged.

Combining adoptive transfer of donor-specific Tregs with low dose IL-2 has a synergistic effect in prolonging MHC-class I–mismatched skin transplant survival due to antigen-driven Treg expansion.

The report details preliminary findings of the NSQIP Transplant beta phase, highlighting significant variation in 30-day postsurgical outcomes beyond basic patient and graft survival.

The authors detect focal protein loss and treat protein-losing enteropathy in a pediatric transplant recipient via surgical revision of the Roux-en-Y loop.

The authors describe a novel technique of synchronous abdominal wall and small bowel transplantation wall in a 37-year-old male with short gut syndrome and loss of domain.

These articles present the current measles outbreaks in the United States, something that could seriously affect nonimmune transplant recipients.