Pro: The Role of Albumin in Pre–Liver Transplant Management

Abstract

The wait‐list mortality of patients with decompensated cirrhosis awaiting liver transplantation remains elevated due to the occurrence of complications. Etiologic treatments improve patient survival and lower the incidence of complications when applied in compensated cirrhosis, but a decompensated disease does not improve or even progress despite a response to therapy in a substantial number of patients. Thus, disease‐modifying treatments that reduce the incidence of complications and improve survival are most needed. Such treatments should be able to counteract one or possibly more pathophysiological mechanisms and thus lead to the proinflammatory and pro‐oxidant milieu that characterizes decompensated cirrhosis. In this respect, albumin represents a potentially ideal agent. In fact, besides its ability to expand plasma volume, albumin possesses nononcotic properties, exerting potent antioxidant and immune‐modulating effects. Recent studies have assessed the effect of longterm albumin administration in decompensated cirrhosis. Although the results of these studies may appear conflicting, their analyses suggest that albumin, if given in a sufficient amount and for a sufficient duration, can significantly reduce the incidence of life‐threatening complications of cirrhosis and patient mortality. For these reasons, we favor albumin administration to patients with decompensated cirrhosis wait‐listed for liver transplantation.

High visceral adipose tissue area is independently associated with early allograft dysfunction in liver transplantation recipients: a propensity score analysis

“…Many previous studies have demonstrated that there is no significant correlation between preoperative serum albumin and patient or graft survival [ 42 , 43 ]. However, in the studies of Hiroi et al [ 44 ] and Bernardi et al [ 45 ], serum albumin can influence short-term outcomes following LT and the albumin administration to patients on wait-listed for LT should be strengthen, which was in line with our results. They hold the view that maintaining high serum albumin level reflects good nutritional status and can reduce the amount of fluid collection in abdominal or thoracic cavity, which could resist the catabolic state induced by surgical stress and inflammatory response in the early postoperative period.…”

“…The clinical and body composition characteristics of patients in the two groups are summarized in Table 1. Median recipient age at transplant was 49 (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) [IQR] years, and 81.1% (n = 142) of patients were male. No significant differences in age and gender were found between the two groups (p = 0.435; p = 0.069, respectively).…”

Long‐term albumin administration in patients with cirrhosis and ascites: A meta‐analysis of randomized controlled trials

“…Because albumin is a multifunctional protein, its supplementation could reduce some of the complications of cirrhosis. Regarding its anti‐inflammatory effects, albumin binds and inactivates many pro‐inflammatory bacterial molecules, cytotoxic agents, and endogenous vasodilators, thus reducing the risk of organic dysfunctions or failures associated with inflammatory states 20,48 …”

Liver Transplantation for Budd-Chiari Syndrome in the MELD Era

“…Reduced albumin is a marker of cirrhosis and is already used in the Child-Pugh score to predict cirrhosis mortality. 31 , 32 Interestingly, neither MELD nor prior TIPS showed a significant association with long-term survival after LT.…”