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Hépato-Gastro & Oncologie Digestive

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A new look on functions and the use of albumin in cirrhosis Volume 22, issue 6, Juin 2015

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Authors
1 Hôpital Jean Minjoz,
service d’hépatologie et de soins intensifs digestifs,
25030 Besançon, France
2 CHU d’Angers,
service d’hépato-gastroentérologie,
Angers, France
3 Faculté de Médecine,
Laboratoire HIFIH UPRES EA 3859,
Angers, France
4 Centre Hospitalier,
service d’hépato-gastroentérologie,
BP 3007, 95503 Gonesse Cedex, France
* Tirés à part

Infusion of exogenous albumin constitutes an essential treatment in the management of patients with decompensated cirrhosis. Both European and American clinical practice guidelines recommend the administration of albumin in case of large-volume paracentesis, spontaneous bacterial peritonitis (SBP) and type 1 hepatorenal syndrome. Moreover, its usefulness is being assessed in other clinical settings. However, the mechanisms underlying the therapeutic effects exerted by albumin are not yet fully understood. Albumin is more than a simple plasma expander and other hemodynamic effects have been recently shown. In cirrhotic patients, albumin improves endothelial dysfunction, reduces peripheral arterial vasodilatation, restores sensitivity to vasoactive agents, and increases cardiac contractility. These effects are mediated by numerous antioxidant, anti-inflammatory, immunomodulatory and ligand-binding properties. Especially, albumin seems to modulate the nitric oxide effects on vascular endothelium. In cirrhotic patients, alterations in the functional capacity of albumin are associated with the reduction of its serum concentration. When non-oxidized albumin accounts for 70% of serum albumin in healthy controls, fractions of oxidized albumin are prevailing in advanced liver failure. These observations led to the concept of effective albumin concentration. Finally, it should be noticed that albumin from different manufacturers may differ markedly in levels of oxidation, although it is not known whether it affects significantly its therapeutic effects.