Use of albumin infusion for cirrhosis-related complications: An international position statement.

Background & Aims

Numerous studies have evaluated the role of human albumin (HA) in managing various liver cirrhosis-related complications. However, their conclusions remain partially controversial, probably because HA was evaluated in different settings, including indications, patient characteristics, and dosage and duration of therapy.

Methods

Thirty-three investigators from 19 countries with expertise in the management of liver cirrhosis-related complications were invited to organise an International Special Interest Group. A three-round Delphi consensus process was conducted to complete the international position statement on the use of HA for treatment of liver cirrhosis-related complications.

Results

Twelve clinically significant position statements were proposed. Short-term infusion of HA should be recommended for the management of hepatorenal syndrome, large volume paracentesis, and spontaneous bacterial peritonitis in liver cirrhosis. Its effects on the prevention or treatment of other liver cirrhosis-related complications should be further elucidated. Long-term HA administration can be considered in specific settings. Pulmonary oedema should be closely monitored as a potential adverse effect in cirrhotic patients receiving HA infusion.

Conclusions

Based on the currently available evidence, the international position statement suggests the potential benefits of HA for the management of multiple liver cirrhosis-related complications and summarises its safety profile. However, its optimal timing and infusion strategy remain to be further elucidated.

Impact and implications

Thirty-three investigators from 19 countries proposed 12 position statements on the use of human albumin (HA) infusion in liver cirrhosis-related complications. Based on current evidence, short-term HA infusion should be recommended for the management of HRS, LVP, and SBP; whereas, long-term HA administration can be considered in the setting where budget and logistical issues can be resolved. However, pulmonary oedema should be closely monitored in cirrhotic patients who receive HA infusion.

Informations de copyright

© 2023 The Author(s).

Déclaration de conflit d'intérêts

ZB, NM-S, FGR, AM, and CAP declare no potential conflicts of interest that pertain to this work. FT’s laboratory received research grants from Gilead, Allergan, Bristol-Myers Squibb and Inventiva. MB, MP, MI, YJW, FGN, RT, CNF, AEM, KP, TT, and SPS declared no potential conflicts of interest concerning the publication of this article. AM received grant funding from Gilead (clinical trials), Inventiva, Intercept, and Novo-Nordisk; and was a member of the advisory board (Gilead). SKS received research funding from Novartis, Durect, Fibronostics, and Gilead. LR, HM, EC, GBLS, LY, S, YY, EV, and AK declared no potential conflicts of interest concerning the publication of this article. FW received grant support from Grifols. RJ is the inventor of OPA, which has been patented by UCL and licensed to Mallinckrodt Pharma. He is also the founder of Yaqrit Discovery, a spin-off company from University College London, Hepyx Limited, and Cyberliver. He has research collaborations with Yaqrit Discovery, has received speaker fees from Grifols, and is a consultant for Ambys, Takeda, and Bioconvergent Health. AOB declared no potential conflicts of interest concerning the publication of this article. MB declared the following potential conflicts of interest with respect to the publication of this article: personal fees from CLS Behring GmbH (consultant, speaker), Grifols SA (consultant, speaker), Takeda (consultant, speaker), PPTA (speaker), and Octapharma (speaker). XQ declared no potential conflicts of interest concerning the publication of this article. He received a governmental grant from the Young and Middle-aged Scientific and Technological Innovation Talents Support Plan Project of Shenyang (RC210011), which does not influence the publication of this article, for holding the final advisory meeting of the position statement. Please refer to the accompanying ICMJE disclosure forms for further details.