Efficacy of Human Albumin Infusion in Advanced Cirrhosis and Acute-on-Chronic Liver Failure: Implications for Renal Protection and Oncologic Outcomes

TL;DR

This study reviews how human albumin infusion helps patients with advanced liver disease, showing benefits for kidney protection and survival, though more research is needed.

Contribution

The study systematically evaluates albumin's efficacy in advanced cirrhosis and ACLF, highlighting its renal and survival benefits.

Findings

Albumin infusion reduces post-paracentesis circulatory dysfunction and acute kidney injury.

It improves survival in selected cirrhosis patients compared to standard care.

Albumin may be more effective than vasoconstrictor-based regimens in some cases.

Abstract

This systematic review evaluated the role of human albumin infusion in patients with decompensated cirrhosis, refractory ascites, acute-on-chronic liver failure (ACLF), and hepatorenal syndrome type 1 (HRS-1). A total of 398 studies were screened, with 125 excluded for not meeting eligibility criteria, and the final selection comprised randomized controlled trials and clinically relevant post hoc analyses published between 2016 and 2024. The findings suggest that albumin infusion confers significant benefits in reducing the incidence of post-paracentesis circulatory dysfunction (PICD), acute kidney injury (AKI), and hyponatremia, while also improving survival in selected patient populations. Comparative trials demonstrated that albumin may outperform standard care and support vasoconstrictor-based regimens, though cost-effectiveness concerns remain when compared to alternatives such as midodrine. The evidence base is strengthened by large multicenter trials with objective outcomes, though limitations include small pilot studies, post hoc subgroup analyses, and heterogeneity in dosing strategies. Overall, albumin infusion appears to be a clinically valuable intervention in the management of advanced cirrhosis, but further trials are warranted to clarify its long-term effects, particularly on hepatocellular carcinoma progression and optimal treatment regimens.

Figures