American Journal of Transplantation

This month “The AJT Report” examines a recent case in which waitlist records were falsified, altering the waitlist priority for patients, and explores its impact on public trust and organ donation. Also, we take a look at the case of a donor-transmitted rabies infection that killed a transplant recipient earlier this year.

New insights into phenotypic and functional heterogeneity of memory B cells have several implications for transplantation.

Immunosuppression for cardiac allografts using proliferation signal inhibitors appears to have a narrow therapeutic index, an increased adverse event profile, and no convincing generalizable impact on the incidence of allograft vasculopathy. See article by Eisen et al on page 1203.

Despite the behavioral limitations of the mathematical modeling described in Chow et al (page 1227), the authors identify the importance of developing a strategy to increase the utilization of donors at increased risk of infectious transmission, and advise caution when designing models to assess risk for rare events.

As enthusiasm for vascularized composite transplantation extends into new potential indications, including lower extremity transplantation, careful consideration of the risks, and cognizance of the benefits of existing treatment modalities, is required to prevent irrational exuberance. See case report by Cavadas et al on page 1343.

The authors review recent advances in understanding the role of plasmacytoid dendritic cells in regulation of immunity, promotion of transplant tolerance, and potential therapeutic effect in clinical transplantation.

The authors report on a public workshop sponsored by the FDA to discuss various topics related to the effects of ischemia reperfusion injury in kidney transplantation, and seek to guide the design of future clinical trials for the development of medical products to prevent or treat this condition.

This viewpoint discusses the application of shared decision making to kidney transplantation to promote patientcentered care, and highlights the opportunities for and challenges of implementation.

Screening a panel of traditional Chinese herbs for immunosuppressive properties reveals that a soluble fraction of Qu Mai inhibits human naïve and effector T cell proliferation and cytokine production while simultaneously inducing regulatory T cells.

The authors demonstrate that inhibition of the cell surface receptor ‘triggering-receptor-expressed-on-myeloidcells-1’ on antigen-presenting cells reduces the infiltration and differentiation of CD4+ lymphocytes and thereby prevents chronic allograft vasculopathy and fibrotic organ remodeling in murine models of allogeneic heart transplantation.

The exacerbation of immune rejection of corneal transplants that occurs in mice with allergic conjunctivitis is due to allergen-induced IL-4, which renders immune effector T cells resistant to the inhibitory effects of T regulatory cells.

Utilizing MHC inbred miniature swine, the authors report that tolerance can be adoptively transferred across a class I mismatched (class II matched) barrier by transplanting tolerated kidneys as well as peripheral blood mononuclear cells into naïve animals.

In this study comparing cardiac transplant recipients receiving one of two doses of everolimus with reduced dose cyclosporine to patients receiving mycophenolate mofetil with standard dose cyclosporine, the authors find no effect on acute cellular rejection, modestly reduced renal function, and a reduction in the incidence and severity of lesions defined by intravascular ultrasound. See editorial by Mehra on page 1119.

Analysis of early and late changes of graft coronary morphology by intravascular ultrasound suggests that while mTOR inhibition by everolimus protects only from early but not from late vascular disease progression, high-dose statin intake is associated with slower vasculopathy progression early and up to years 5 after transplant.

Using a novel patient-perspective Markov model, this study informs the clinical decision of accepting kidneys from infectious risk donors. See editorial by Turgeon et al on page 1121.

This international multicenter study finds that C4d staining on paraffin sections is of limited reproducibility between institutions, and its authors provide recommendations for improving and standardizing C4d staining.

This study reports early promising results from a pilot experience with ex vivo normothermic kidney perfusion using extended criteria donor kidneys.

The authors find no relationship between biopsy-proven acute rejection and tacrolimus predose concentrations, and posit that it is not possible to define the optimal target concentrations for tacrolimus.

The authors report on an experience using transvenous renal transplant biopsy to enable histological evaluation in patients unsuitable for percutaneous transplant biopsy.

Labial microvasular tortuosity, a surgate measure of generalized microvascular disease, is reversed after simultaneous pancreas—kidney transplantation.

Studying a rare type of human liver transplantation that allows regeneration of the recipient liver, the authors demonstrate that successful and failed regeneration are accompanied by changes in miRNA expression that govern cell cycle fate.

De novo cancer is the leading cause of late death in Australian liver and cardiothoracic transplant recipients.

Gene expression profiling reveals clear differences between EBV-positive and EBV-negative posttransplant lymphoproliferative disorders.

Utilization of kidney paired donation remains concentrated among a small number of transplant centers, and as such is yet to optimally realize its potential to boost live donor transplant availability.

The authors report on a recent case series of kidney transplants from donors after cardiac death with promising results.

This study demonstrates the technical feasibility of normothermic machine perfusion of human donor livers.

In living-donor lobar lung transplantation, donor grafts overinfl ate or underinfl ate to the extent that they can preserve their native function in the new recipient's environment.

The authors present the 12-month results of a bilateral transfemoral transplantation of the lower extremities. See editorial by Vicente et al on page 1123.

A case of an inadvertent ABO-incompatible lung transplant suggests some low-titer ABO antibody recipients can achieve long-term survival.

Updated adult immunization guidelines include the use of PCV13 for immunocompromised adults, zoster vaccine for “normal” hosts at age 60 and expanded indications for human papillomavirus vaccination in young adult men.