Use of albumin infusion for cirrhosis-related complications: An international position statement
Zhaohui Bai,
Nahum Méndez-Sánchez,
Fernando Gomes Romeiro,
Andrea Mancuso,
Cyriac Abby Philips,
Frank Tacke,
Metin Basaranoglu,
Massimo Primignani,
Mostafa Ibrahim,
Yu Jun Wong,
Filipe Gaio Nery,
Rolf Teschke,
Carlos Noronha Ferreira,
Alberto E. Muñoz,
Kanokwan Pinyopornpanish,
Thierry Thevenot,
Shivaram Prasad Singh,
Arpan Mohanty,
Sanjaya K. Satapathy,
Lorenzo Ridola,
Hitoshi Maruyama,
Evangelos Cholongitas,
Giovanni Battista Levi Sandri,
Li Yang,
Shalimar,
Yongping Yang,
Erica Villa,
Aleksander Krag,
Florence Wong,
Rajiv Jalan,
Alastair O’Brien,
Mauro Bernardi,
Xingshun Qi
Affiliations
Zhaohui Bai
Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China; Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China
Nahum Méndez-Sánchez
Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico
Fernando Gomes Romeiro
Internal Medicine Department, Botucatu Medical School, São Paulo, Brazil
Andrea Mancuso
Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy
Cyriac Abby Philips
Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, India
Frank Tacke
Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
Metin Basaranoglu
Division of Gastroenterology, Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey
Massimo Primignani
Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Mostafa Ibrahim
Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
Yu Jun Wong
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
Filipe Gaio Nery
Serviço de Cuidados Intensivos, Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar Universitário do Porto, Porto, Portugal
Rolf Teschke
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Germany
Carlos Noronha Ferreira
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
Alberto E. Muñoz
Sección Hepatología, Hospital Dr. Carlos B. Udaondo. Ciudad Autónoma de Buenos Aires, Argentina
Kanokwan Pinyopornpanish
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Thierry Thevenot
Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d’Hépatologie et de Soins Intensifs Digestifs, Besançon, France
Shivaram Prasad Singh
Kalinga Gastroenterology Foundation, Odisha, India
Arpan Mohanty
Section of Gastroenterology, Boston Medical Center, Boston, MA, USA
Sanjaya K. Satapathy
Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York, USA
Lorenzo Ridola
Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome, Italy
Hitoshi Maruyama
Department of Gastroenterology, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
Evangelos Cholongitas
First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
Giovanni Battista Levi Sandri
Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
Li Yang
Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
Shalimar
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
Yongping Yang
Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
Erica Villa
Department of Gastroenterology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Italy
Aleksander Krag
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
Florence Wong
Department of Medicine, University of Toronto, Toronto, ON, Canada
Rajiv Jalan
Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, University College London, London, UK
Alastair O’Brien
Division of Medicine, Royal Free Campus, London, UK
Mauro Bernardi
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy.
Xingshun Qi
Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China; Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China; Corresponding authors: Addresses: Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenyang, Liaoning Province, 110840, China; Tel.: 86-18909881019; fax: 86-02428851113
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.
