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The role of albumin in pre-liver transplant management

Bernardi M, Zaccherini G, Caraceni P
4 December, 2019  

Liver transplantation is a treatment option for patients with decompensated cirrhosis and some of its life-threatening complications.

However, the mortality rates among patients awaiting a transplant remain high. Although drugs such as antiviral agents for hepatitis can decrease the development of complications of cirrhosis, new and more effective treatments are needed to prevent progression to end-stage liver disease while on a transplant waitlist.

This article reviews the pathophysiological mechanisms of decompensated cirrhosis and the evidence supporting the long-term use of albumin in this indication. Albumin, a plasma volume expander, presents antioxidant, anti-inflammatory, haemostatic, vasoconstrictive , and immunomodulating properties.

The current treatment guidelines recommend it to prevent circulatory anomalies induced by paracentesis and renal dysfunction caused by spontaneous bacterial peritonitis, as well as to manage symptoms of hepatorenal syndrome associated with the administration of vasoconstrictors.

Recent clinical studies conducted in patients with decompensated cirrhosis and uncomplicated or refractory ascites showed lower overall mortality rates with albumin and a significant reduction in hospitalisations. By contrast, in patients who were candidates for liver transplantation, the one-year mortality rates did not change.

The authors describe the limitations for these studies, compare the schedules of albumin administration used, and discuss future research in this field.