American Journal of Transplantation

This month, “The AJT Report” looks at the flat growth of NIH funding in recent years, and how the presidential election may impact future funding. Also this month, the concern of several researchers over the lung allocation system's effectiveness is examined.

A new report describes a fascinating chain of events in two different mouse models of obesity and nonalcoholic steatohepatitis that may fundamentally change thinking about many obesity-associated diseases, and have farreaching implications for transplantation.

The author provides historical and practical perspective for recently reported clinical advances in tolerance induction through mixed chimerism. See article by Scandling et al on page 1133.

This editorial summarizes the current evidence and the authors' perspective regarding the role of mTOR inhibitors and cancer in kidney transplant recipients. See article by Campbell et al on page 1146.

The authors describe the findings of Wiebe et al (page 1157) that de novo donor-specific HLA antibodies have adverse prognostic implications for long-term renal transplant survival and discuss how these findings may impact individual patient care and direct future research.

The authors review the biology of homeostatic proliferation stimulated by lymphopenia, the effects of specific depleting agents on reconstitution of the T and B cell immune repertoire, and potential strategies to enhance allodepletion while minimizing the adverse effects of homeostatic proliferation.

The authors review issues influencing expanded criteria donor and living donor transplant opportunities for the elderly, and present future considerations to maintain or improve access to transplantation for seniors in the context of new kidney allocation concepts.

The overriding principle of organ transplantation biovigilance efforts should be an increase in the benefit for potential transplant recipients, rather than an aversion for disease transmissions through the donated organ.

This article demonstrates the roles of CD4⁺ and CD8⁺ T cells and antibodies in the process of platelet transfusioninduced bone marrow transplant rejection across minor antigen barriers for MHC identical donors and recipients.

MicroRNAs are differentially expressed between allogeneic and syngeneic heart grafts, suggesting potentially important regulatory functions in graft rejection.

This study demonstrates the critical role of recipient regulatory T cell proliferation and expansion in the protection of islet transplants from recurrent autoimmunity.

In a cohort of 16 patients given kidney and hematopoietic cell transplants enrolled in a tolerance induction protocol, 11 have been withdrawn from immunosuppressive drugs with observations for up to 3 years thereafter without evidence of acute or chronic rejection. See editorial by Bradley on page 1073.

This prospective, multicenter, randomized study designed to specifically evaluate skin malignancy in kidney transplant recipients demonstrates that conversion to sirolimus reduces the incidence and delays the occurrence of nonmelanoma skin cancer when compared with continuation of calcineurin inhibitors. See editorial by Wong et al on page 1075.

Prospective monitoring for de novo donor-specific antibody in renal transplantation using clinical, serological and histopathological methods uncovers distinct clinical phenotypes and the pathology associated with them, as well as the independent risk factors for their development. See editorial by Kokko and Colvin on page 1077.

This study proposes a new diagnostic algorithm to distinguish antibody-mediated microcirculation inflammation from antibody-independent etiologies in conventional nonhighly presensitized kidney transplants, and defines a grading threshold for microcirculation inflammation with a high specificity for antibody-mediated rejection.

This study of NK cell transcripts and T cell transcripts in kidney transplant biopsies confirms that NK cell transcripts are high in late antibody-mediated rejection but are also elevated in some early T cell–mediated rejection, possibly due to T cells expressing NK features.

Everolimus as compared with cyclosporine is associated with higher rates of de novo donor-specific HLA-antibody formation and antibody-mediated rejection after kidney transplantation.

This study analyzes “graft interstitial fibrosis associated with inflammation” after kidney transplantation, the factors that relate to its development, and its implications for graft survival.

This large multicenter series from the A2ALL consortium provides a definitive report of the incidence and severity of live liver donor complications, and includes long-term follow-up allowing for a definition of the natural history of complications.

A peripheral blood QPCR-based algorithm based on the measurement of three gene transcripts can detect the acquisition of operational tolerance in children and adult recipients of liver transplants.

Compared to actual graft weight, accurate hemi-liver volume can be estimated using right and left portal vein diameter and several standard liver volume formulae.

This article describes a model to predict the risk of in-hospital mortality in children undergoing heart transplant in the US, which the authors validated both internally in their development cohort and externally in a prospective cohort.

Lung transplantation in patients with prior cardiothoracic surgical procedures remains technically challenging, with inferior outcomes and higher incidences of major complications compared to those seen in patients without prior cardiothoracic procedures.

The authors find that pretransplant hypoalbuminemia is independently associated with early mortality after lung transplantation.

The authors demonstrate that elevated circulating levels of immunoglobulin free light chains are associated with an increased risk of posttransplant lymphoproliferative disorder.

Acute insulin response to an intravenous glucose tolerance test is the most reliable predictor of insulin independence at one year after pancreatic islet transplantation in type 1 diabetic recipients.

Donor brain death abrogates tolerance induction in a preclinical lung transplant model.

The authors describe the engraftment of cynomolgus islet allografts persisting months following cessation of therapy with a triple therapy regimen (power mix).

Exclusion of small hypointense spots, which would represent nonfunctioning byproducts of islet transplantation, improves the quantification of the functional islet mass based on islet MRI, suggesting a useful principle in the development of an algorithm to estimate functioning islet mass based on islet MRI.

Lentivirus-mediated Programmed Death-Ligand 1 overexpression in rat donor corneal transplants significantly prolongs allograft survival and is associated with a reduced infiltration of inflammatory cells and pro-inflammatory cytokine expression in the graft.

The authors report on the technical, clinical and oncological feasibility of novel multivisceral ex vivo surgery performed in three patients.

The authors describe a successful case of living donor liver transplantation in which the donor was identified predonation as having antithrombin deficiency.

This year's updated vaccine recommendations expand the administration of hepatitis B vaccine to include diabetics younger than 60 as soon as they are diagnosed and the use of human papillomavirus vaccine for previously unvaccinated immunocompromised males aged 22–26.

Updated pediatric vaccine recommendations now include universal vaccination of boys with human papillomavirus vaccine.