Hépato-Gastro & Oncologie Digestive


Use of albumin in decompensated cirrhosis: Towards new concepts Volume 29, issue 4, April 2022


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1 Centre hospitalier universitaire Jean Minjoz, Service d’hépatologie et de soins intensifs digestifs, 3 boulevard Alexandre Fleming, 25030 Besançon
2 Inserm, Université de Paris, Centre de recherche sur l’inflammation (CRI), Paris ; Hôpital Beaujon, AP-HP, Service d’hépatologie, 100 Bd du Général Leclerc, 92118 Clichy
3 European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelone, Espagne
* Correspondance : T. Thévenot

Human albumin is recommended for the prevention of post-paracentesis circulatory dysfunction, for the treatment of spontaneous bacterial peritonitis (SBP) in combination with antibiotic therapy, and for the identification and treatment of patients with hepatorenal syndrome. In addition to its oncotic properties, human albumin has numerous functions, including anti-inflammatory functions, which could extend its potential clinical benefit in other therapeutic indications such as bacterial infections other than SBP; however, the improvement in survival has not yet been demonstrated. Because of the extensive damage of the molecular structure of albumin due to the underlying oxidative stress observed in cirrhotic patients, the proportion of the functional albumin (i.e, the “effective” albumin) declines in parallel with the progression of cirrhosis. This new concept of serum “effective albumin” concentration could have an important prognostic role in the near future and could be used to guide albumin therapy in a more effective way than the total albumin concentration. A proper monitoring of patients following high dose of albumin infusion is required because of the risk of volume overload. Clinical ongoing trials using “liver dialysis device” will provide further evidence for albumin therapy in decompensated cirrhotic patients.