American Journal of Transplantation: Volume 21, Number 5, May 2021

On the cover: Just as our preoccupation with SARS-CoV-2 infection may be waning at both the professional and personal levels, two rigorous nationwide studies remind us of the substantial morbidity and mortality imposed on transplant recipients by more traditional viral enemies. Mombelli and colleagues (page 1789) present a remarkable Swiss observational cohort study of nearly 3300 transplant recipients with prospectively collected data related, including microbiologically, to diagnosed respiratory virus infections. They report that, while respiratory tract infections were associated with graft loss and death in non–lung transplant recipients, lower respiratory tract and influenza infections were associated with graft loss and death in both lung and non–lung transplant recipients. Helanterä and colleagues (page 1848) focused specifically on influenza in Finland, reporting on more than 3900 kidney transplant recipients. Compared to the general Finnish population of approximately 5.5 million, kidney transplant recipients have a greater than fivefold increased standardized incidence ratio (SIR) for laboratory-confirmed influenza and a greater than fourfold SIR for hospitalization. Among hospitalized recipients, mortality was high (21/152; 14%). Both studies, considered within the context of remarkably low influenza activity this past season, highlight the importance of prevention. Influenza vaccination and the judicious practice of physical distancing, handwashing, and masking will, ideally, represent the ounce of prevention to avoid the pound of cure. Cover design by Megan Llewellyn, Duke University Section of Surgical Disciplines.