Albumin mass balance and kinetics in liver transplantation

Amouzandeh, Mariam; Nowak, Greg; Januszkiewicz, Anna; Wernerman, Jan; Rooyackers, Olav; Norberg, Åke

doi:10.1186/s13054-018-2053-6

Cited by 20 publications

(19 citation statements)

References 34 publications

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“…Rezente Tracer-Studien zeigten, dass es im Rahmen von großen abdominellen Eingriffen innerhalb der ersten Stunde nach Beginnder Operationzu transkapillarenAlbuminverlusten kommt. Dementsprechend kann perioperativ ein Abfall des Albuminspiegels im Serum beobachtet werden [2,31]. Eine präoperative Hypoalbuminämie kann dadurch postoperativ signifikant zunehmen.…”

Section: Albumin In Der Chirurgieunclassified

Einsatz von Albumin

Mayerhöfer

Wiedermann

Joannidis

2021

Med Klin Intensivmed Notfmed

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ZusammenfassungDie Saline vs. Albumin Fluid Evaluation (SAFE) Studie hat gezeigt, dass der Einsatz von Albumin als Infusionslösung im Bereich der Volumentherapie fast überall sicher ist. Eine Ausnahme stellt hypoonkotisches Albumin beim Schädel-Hirn-Trauma dar. Während für Patientinnen und Patienten mit Leberzirrhose klare Indikationen existieren, fehlen für andere Einsatzgebiete noch große Studien, die einen klinisch relevanten Vorteil jenseits der hämodynamischen Wirksamkeit zweifelsfrei zeigen konnten und damit einen breiteren Einsatz rechtfertigen würden. Bei der „Large-volume“-Parazentese, der spontanen bakteriellen Peritonitis, aber auch beim hepatorenalen Syndrom ist der Einsatz von Albumin aufgrund eines klinischen Benefits in randomisierten kontrollierten Studien klar empfohlen und etabliert. Beim septischen Schock kann ein Einsatz von Albumin in Erwägung gezogen werden, wobei sich zwei große Studien zu dieser Fragestellung in Deutschland und Italien noch in der Rekrutierungsphase befinden. Für viele Einsatzgebiete in der Volumentherapie gilt, dass Albumin vor allem dann eingesetzt werden kann, wenn andere Maßnahmen zur hämodynamischen Stabilisierung bereits ausgeschöpft sind. Das gilt sowohl für die Volumengabe bei Hypovolämie als auch für das konservative Volumenmanagement einschließlich der sog. Deresuscitation-Phase. Inwieweit die Korrektur einer ausgeprägten Hypoalbuminämie durch Gabe von exogenem Albumin auch das schlechtere Outcome solcher Patientinnen und Patienten verbessert, ist ebenfalls Teil laufender Studien. Auf dem Weg zu einem Mehr an individualisierter Therapie kann in Zukunft die Hypoalbuminämie bei Entscheidungen für oder gegen einen Einsatz von intravenösen Albuminlösungen in der Volumentherapie eine wichtige Rolle einnehmen.

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Section: Albumin In Der Chirurgieunclassified

Einsatz von Albumin

Mayerhöfer

Wiedermann

Joannidis

2021

Med Klin Intensivmed Notfmed

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“…Beneficial properties were attributed to Alb in recent studies; whereas, postoperative hypoalbuminemia has been linked to the development of acute kidney injury (AKI) [18]. It has been found that during LT there is translocation of Alb, probably to the interstitial space, which persists until the third postoperative day and whose role has not been clearly clarified [19]. Certain centers choose to replace two-thirds of the required fluids with crystalloids and one-third of drain losses with albumin [14].…”

Section: Hemodynamic Stabilization and Monitoringmentioning

confidence: 99%

Management of Patients with Liver Transplantation in ICU

Karapanagiotou¹,

Pitsoulis²,

Vasileiou³

et al. 2019

Liver Disease and Surgery [Working Title]

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Liver transplantation constitutes the most effective and indispensable treatment of end-stage liver disease (ESLD). Major advances in surgical techniques, anesthesiological management, postoperative care, immunosuppression, and diagnostic approach have led to increased overall survival of patients. Postoperative care poses a great challenge since detrimental occurrences that need prompt treatment may affect the graft or distant organ functionality. Adequate graft function is strongly associated with distant organ restoration and rapid patient recovery. In the ICU setting, the main focal points are hemodynamic stabilization, coagulation and electrolyte disturbances correction, respiratory support, early weaning from mechanical ventilation, and evaluation of graft functionality. It is of paramount importance to facilitate early graft recovery, recognize and promptly treat systematic complications and life-threatening sequelae, and individualize treatment protocols considering graft quality, donor's and recipient's health status, and potential co-morbidities. To achieve those goals, technological advancements in continuous patient monitoring, graft functionality, and its metabolic reserves must be assimilated and implemented in the ICU.

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“…Preoperative hypoalbuminemia has also been confirmed as an indicator for poor nutritional status, and postoperative complication after spine surgery ( 7 ), GI surgery ( 8 ), and acute kidney injury ( 9 ). Because albumin has quick kinetics after surgery, which can even occur earlier than that of CRP, making it an intense focus of perioperative management ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

The Risk Factors for Perioperative Serum Albumin Variation in Pediatric Patients Undergoing Major Gastroenterology Surgery

et al. 2021

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Background: The albumin, a negative acute-phase protein, is important for perioperative morbidity, even in patients with normal preoperative levels. This study intend to determine the perioperative factors related with the postoperative reduction in serum albumin (ΔALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 pediatric patients who underwent major gastroenterology surgery from August 2010 to August 2019. The patients were dichotomized into a high ΔALB group (≥14.6%) and a low ΔALB group (<14.6%) based on the mean value of ΔALB (14.6%). the independent risk factors for ΔALB, were explored using the propensity score matching to minimize potential selection bias and subjected to method multivariable logistic regression model. Furthermore, in 366 matched patients, the influences of operating time on perioperative outcomes were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 [odds ratio (OR) = 2.36 (95% CI, 1.51–3.86); p = 0.007], a longer operating time [OR = 1.18 (95% CI, 1.00–1.53); p = 0.014), and the presence of Charcot's triad [OR = 1.73 (95% CI, 1.05–2.83); p = 0.031] were factors that predicted a high ΔALB level. A high ΔALB level was also related with gastrointestinal functional recovery delay, reflected by the postoperative defecation (p = 0.013) and bowel movement (p = 0.019) delay and the high occurrence of postoperative complications (16.1 vs. 10.9%, OR, 1.57; 95% CI, 1.02–2.41, P = 0.0026).Conclusions: The high ΔALB level was correlated with postoperative outcome. To obtain a safe recovery and discharge after a major abdominal operation, the above risk factors for ΔALB could be addressed in the perioperative period.

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Albumin mass balance and kinetics in liver transplantation

Cited by 20 publications

References 34 publications

Einsatz von Albumin

Einsatz von Albumin

Management of Patients with Liver Transplantation in ICU

The Risk Factors for Perioperative Serum Albumin Variation in Pediatric Patients Undergoing Major Gastroenterology Surgery

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