Author information

¹Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China.

²Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China.

³Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico.

⁴Internal Medicine Department, Botucatu Medical School, São Paulo, Brazil.

⁵Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy.

⁶Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, India.

⁷Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany.

⁸Division of Gastroenterology, Department of Internal Medicine, Bezmialem Vakif University, Istanbul, Turkey.

⁹Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

¹⁰Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.

¹¹Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.

¹²Serviço de Cuidados Intensivos, Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar Universitário do Porto, Porto, Portugal.

¹³Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Germany.

¹⁴Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.

¹⁵Sección Hepatología, Hospital Dr. Carlos B. Udaondo. Ciudad Autónoma de Buenos Aires, Argentina.

¹⁶Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

¹⁷Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz, Service d'Hépatologie et de Soins Intensifs Digestifs, Besançon, France.

¹⁸Kalinga Gastroenterology Foundation, Odisha, India.

¹⁹Section of Gastroenterology, Boston Medical Center, Boston, MA, USA.

²⁰Department 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.

²¹Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.

²²Department of Gastroenterology, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan.

²³First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

²⁴Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.

²⁵Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China.

²⁶Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

²⁷Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.

²⁸Department of Gastroenterology, University of Modena & Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Italy.

²⁹Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

³⁰Department of Medicine, University of Toronto, Toronto, ON, Canada.

³¹Liver Failure Group, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, University College London, London, UK.

³²Division of Medicine, Royal Free Campus, London, UK.

³³Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Abstract

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.