American Journal of Transplantation: Volume 21, Number 12, December 2021

On the cover: As 2021 comes to a close, the transplantation community continues to learn from the COVID-19 pandemic, albeit having progressed from elementary to graduate school lessons. While 2020 was focused on infection, disease severity, risk factors, and outcomes, 2021 was dominated by vaccines. In this issue, we have no less than 5 articles and 3 letters delineating and/or discussing the response of transplant recipients to COVID vaccines. However, as we anticipate 2022, the transplant community will undoubtedly learn about using various organs from donors with recent or active COVID-19, a theme foreshadowed by two articles in this issue. Romagnoli et al. (page 3919) from Italy report on the successful transplantation, without SARS-CoV-2 transmission, of 10 livers from deceased donors with active COVID-19. Notably, the 10 recipients comprised of 5 who recovered from severe COVID-19, 3 who were affected by mild COVID-19, and 2 who were suspected to have had COVID-19. Querrey and colleagues (page 4073) transplanted lungs from a donor 7 weeks after symptomatic COVID-19 into a recipient who developed progressive pulmonary fibrosis after severe COVID-19 acute respiratory distress syndrome. Another lesson comes from both the United Kingdom (page 4095) and France (page 4098) related to transplanting organs from donors with COVID-19 vaccine-induced thrombosis and thrombocytopenia. The editorial by Wolfe and Humar (page 3829) brings perspective to these two contrasting case series. Cover design by Lauren Halligan, Duke University Section of Surgical Disciplines.