SARS-CoV-2 infection has been a challenge for health systems worldwide, causing a dramatic consumption of resources to cope with this pandemic caused by this recently identified virus. Solid information about SARS-CoV-2 (from a pathophysiological, clinical and therapeutic point of view) is scarce. On many occasions, these questions have been answered based on available knowledge from similar viruses such as SARS-CoV and MERS.

Due to the potential severity of this disease and the absence of current tools able to definitively modify its natural history, many are the ongoing research works that have been started since the description of the first case of COVID-19. Currently, our clinical practice in this type of infection is based on data especially from retrospective studies whose scientific power is questionable and which, on many occasions, provide contradictory messages.

These handicaps associated with the management and knowledge of COVID-19 extend, even with a greater lack of knowledge, to the population of recipients of a solid organ transplant (SOT) and to organ donation protocols, which have been adapted (in occasions drastically) to this new scenario. However, again, the data that supports these protocols and the available evidence on the management of organ donation and the recipient of a SOT are, likewise, of little scientific solidity.

As a result of this absence of solid evidence that allows for a significant improvement in the management of this risk population, The International Database on Organ donation and Transplantation – COVID19 (IDOTCOVID) has been designed. The present database tries to exhaustively collect the demographic, clinical, analytical and therapeutic data that of SOT recipients with COVID-19 and, afterwards, to extrapolate large-scale conclusions to provide reliable information and, more importantly, to guide in a solid way the future management of this population.

One of the main objectives of this project is the development of a tool that helps in the management of immunosuppression and the treatment of COVID19 infection in SOT recipients.

To achieve this, the following objectives have been designed to be developed in stages and progressively:


1. Creation of an international database that includes all SOT recipient patients with COVID19 infection (confirmed or suspected);

2. Inclusion of different clinical and analytical data with recognized prognostic factor in the general population;

3. Inclusion of treatment data, including management of immunosuppression and clinical outcomes;

4. Development of a Machine Learning algorithm that can assist the scientific community in updating their treatment management and immunosuppression protocols in this high-risk population;


Highlighted Articles:

May 5 - PERSONAL VIEWPOINT - Utilization of deceased donors during a pandemic: An argument against using SARS‐CoV‐2 positive donors
View Article

May 12 - PERSONAL VIEWPOINT - Use of SARS‐CoV‐2 infected deceased organ donors: Should we always “just say no?”
View Article

This week's selection made by: Enver Akalin, Marlies Reinders, Pablo Uva, Nithya Krishnan, Manisha Sahay, Shannon Grappe and Annmarie Liapakis

Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology.

Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, Swaminathan S; COVID-19 and ACE2 in Cardiovascular, Lung, and Kidney Working Group.
J Am Soc Nephrol. 2020 May 4.

This article emphasizes that AKI can be a severe complication of COVID-19 and the importance of assessing, defining, and reporting the course of AKI is highlighted.

Immediate impact of COVID-19 on transplant activity in the Netherlands.

de Vries APJ, Alwayn IPJ, Hoek RAS, van den Berg AP, Ultee FCW, Vogelaar SM, Haase-Kromwijk BJJM, Heemskerk MBA, Hemke AC, Nijboer WN, Schaefer BS, Kuiper MA, de Jonge J, van der Kaaij NP, Reinders MEJ.
Transpl Immunol. 2020 May 1:101304.

This article describes the enormous impact of COVID-19 on transplant activity in the Netherlands. There was a significant decrease in organ donation numbers affecting all organ transplant services and detrimental effect on transplantation numbers in children with end-organ failure. The paper also describes ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

Pharmacologic treatment of transplant recipients infected with SARS-CoV-2: considerations regarding therapeutic drug monitoring and drug-drug interactions.

Elens L, Langman LJ, Hesselink DA, Bergan S, Moes DJAR, Molinaro M, Venkataramanan R, Lemaitre F.
Ther Drug Monit. 2020 Apr 15.

This article inform the clinicians about the potential interactions of experimental COVID-19 treatments with immunosuppressive drugs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.

Utilization of deceased donors during a pandemic: An argument against using SARS-CoV-2 positive donors.

Shah MB, Lynch RJ, El-Haddad H, Doby B, Brockmeier D, Goldberg DS.
Am J Transplant. 2020 May 5

This article presents a review of the current literature that details the potential negative consequences of COVID-19 positive donors. The authors concluded that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplantation societies.

Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19.

Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, Labella A, Manson D, Kubin C, Barr RG, Sobieszczyk ME, Schluger NW.
N Engl J Med. 2020 May 7. 

This observational study involving 1446 patients with Covid-19 who had been admitted to the hospital documented that hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death. 

The Society of Pediatric Liver Transplantation (SPLIT), a section of TTS, and the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) have partnered to create a secure and de-identified online pediatric registry (for patients under the age of 21 years). Our intention is to collect and disseminate the experience of our community to better understand the clinical presentation, natural history and long-term outcomes in our hepatology and liver and intestinal transplant population. We are requesting all clinicians worldwide to report all cases of COVID -19 in children with chronic liver diseases (still with native liver), listed for pediatric liver/intestine transplantation, or have undergone liver and/or intestinal transplantation.    

We encourage you to complete this form even if the patient is in the middle of their COVID-19 course. This allows for timely dissemination back to our community. A weekly summary of COVID cases will be reported on the SPLIT COVID listserv, the NASPGHAN GI listserv and the NASPGHAN COVID website.     

To submit a case, please use this link or copy and paste the following url: https://is.gd/naspghansplitliversurvey    

Thank you to everyone in our community that is coming together at this time and for your efforts to serve our hepatology and transplant patients and support each other.   Sincerely,


• Mohit Kehar, Pediatric Gastroenterologist and Hepatologist, Queens University

• Mercedes Martinez, Chair of the NASPGHAN Hepatology Committee and Medical Director of Intestinal Transplantation, Columbia University

• Noelle Ebel, Transplant Hepatologist, Stanford University

• Steven Lobritto, Chair of the SPLIT Quality Improvement and Clinical Care Committee, Medical Director of Pediatric Liver Transplantation, Columbia University

• Vicky Ng, SPLIT President and Medical Director of Pediatric Liver Transplantation, University of Toronto    




This study has been granted REB/IRB clearance according to the recommended principles of Queen's University and Columbia University.



This week's selection made by: Enver Akalin, Marcelo Cantarovich and Medhat Askar

Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology.

Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, Swaminathan S; COVID-19 and ACE2 in Cardiovascular, Lung, and Kidney Working Group.
J Am Soc Nephrol. 2020 May 4.

This article emphasizes that AKI can be a severe complication of COVID-19 and the importance of assessing, defining, and reporting the course of AKI is highlighted.

Immediate impact of COVID-19 on transplant activity in the Netherlands.

de Vries APJ, Alwayn IPJ, Hoek RAS, van den Berg AP, Ultee FCW, Vogelaar SM, Haase-Kromwijk BJJM, Heemskerk MBA, Hemke AC, Nijboer WN, Schaefer BS, Kuiper MA, de Jonge J, van der Kaaij NP, Reinders MEJ.
Transpl Immunol. 2020 May 1:101304.

This article describes the enormous impact of COVID-19 on transplant activity in the Netherlands. There was a significant decrease in organ donation numbers affecting all organ transplant services and detrimental effect on transplantation numbers in children with end-organ failure. The paper also describes ongoing efforts focus on mitigation of not only primary but also secondary harm of the pandemic and to find right definitions and momentum to restore the transplant programs.

Pharmacologic treatment of transplant recipients infected with SARS-CoV-2: considerations regarding therapeutic drug monitoring and drug-drug interactions.

Elens L, Langman LJ, Hesselink DA, Bergan S, Moes DJAR, Molinaro M, Venkataramanan R, Lemaitre F.
Ther Drug Monit. 2020 Apr 15.

This article inform the clinicians about the potential interactions of experimental COVID-19 treatments with immunosuppressive drugs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.

Utilization of deceased donors during a pandemic: An argument against using SARS-CoV-2 positive donors.

Shah MB, Lynch RJ, El-Haddad H, Doby B, Brockmeier D, Goldberg DS.
Am J Transplant. 2020 May 5

This article presents a review of the current literature that details the potential negative consequences of COVID-19 positive donors. The authors concluded that COVID-19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplantation societies.

Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19.

Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, Labella A, Manson D, Kubin C, Barr RG, Sobieszczyk ME, Schluger NW.
N Engl J Med. 2020 May 7. 

This observational study involving 1446 patients with Covid-19 who had been admitted to the hospital documented that hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end point of intubation or death.