Liver Transplantation for Hepatitis C and Alcoholic Liver Disease

End-stage liver disease due to hepatitis C (HCV) and cirrhosis from alcohol (ALD) are the commonest indications for liver transplantation in the western countries. Up to one third of HCV-infected transplant candidates have a history of significant alcohol intake prior to transplantation. However, there are few data available about the possible interaction between alcohol and HCV in the post-transplant setting. Patients with both HCV and alcohol are more likely to die on the waiting list than those with ALD and HCV alone. However, after transplantation, non-risk adjusted graft and patient survival of patients with HCV + ALD are comparable to those of patients with HCV cirrhosis or ALD cirrhosis alone. In the short and medium term HCV recurrence after transplant in patients with HCV + ALD cirrhosis does not seem more aggressive than that in patients with HCV cirrhosis alone. A relapse in alcohol consumption in patients with HCV + ALD cirrhosis does not have a major impact on graft survival. The evidence shows that, as is currently practiced, HCV + ALD as an appropriate indication for liver transplantation. However, these data are based on retrospective analyses with relatively short follow-up so the conclusions must be treated with caution

Hepatitis C and Kidney Transplantation

Hepatitis C virus (HCV) infection is relatively common among patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation (SKL) should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe

A Bifurcation Lemma for Invariant Subspaces

The Bifurcation from a Simple Eigenvalue (BSE) Theorem is the foundation of steady-state bifurcation theory for one-parameter families of functions. When eigenvalues of multiplicity greater than one are caused by symmetry, the Equivariant Branching Lemma (EBL) can often be applied to predict the branching of solutions. The EBL can be interpreted as the application of the BSE Theorem to a fixed point subspace. There are functions which have invariant linear subspaces that are not caused by symmetry. For example, networks of identical coupled cells often have such invariant subspaces. We present a generalization of the EBL, where the BSE Theorem is applied to nested invariant subspaces. We call this the Bifurcation Lemma for Invariant Subspaces (BLIS). We give several examples of bifurcations and determine if BSE, EBL, or BLIS apply. We extend our previous automated bifurcation analysis algorithms to use the BLIS to simplify and improve the detection of branches created at bifurcations.Comment: 22 pages, 7 figure