Service d'Hépato-Gastroentérologie, Centre Hospitalier, BP 3007, 95503 Gonesse Cedex
Albumin constitutes an essential treatment in clinical hepatology. After large volume paracentesis, there is a high risk of circulatory disturbance which is associated with a shorter time to readmission for ascites and shorter survival. Albumin infusion (7 g/l of ascitic fluid removed) reduces the incidence of this circulatory dysfunction from more than 75 % when the procedure is performed without albumin to approximately 15 % when it is used. In patients with spontaneous bacterial peritonitis, albumin infusion in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone. This beneficial effect is mainly observed in high risk patients (bilirubin > 70 μmol/l and/or creatinine > 90 μmol/l). As a diagnostic criteria of hepatorenal syndrome, a volume expansion with i.v. albumin (1 g/kg body weight) should be performed to rule out any reduction in plasma volume as the cause of renal failure. Reversal of type 1 hepatorenal syndrome is more frequent after the simultaneous administration of albumin and terlipressin than after administration of terlipressin alone. In all these pathological conditions, albumin infusion is used to increase rapidly the circulating blood volume. However albumin is not just a plasma expander. It has many other physiological properties, especially detoxification and antioxydant functions. These properties could be the basis for new potential therapeutic indications in patients with cirrhosis whose native albumin functional capacity could be severely altered.