Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review

Duilio Pagano; Pierluigi Toniutto; Patrizia Burra; Salvatore Gruttadauria; Roberta Vella; Silvia Martini; Maria Cristina Morelli; Gianluca Svegliati Baroni; Giuseppe Marrone; Francesca Romana Ponziani; Paolo Caraceni; Paolo Angeli; Vincenza Calvaruso; Valerio Giannelli; Commission of Liver Transplantation of the Italian Association for the study of Liver Diseases (AISF)

doi:10.1016/j.dld.2024.11.006

Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review

Dig Liver Dis. 2024 Dec 6:S1590-8658(24)01097-1. doi: 10.1016/j.dld.2024.11.006. Online ahead of print.

Authors

Duilio Pagano¹, Pierluigi Toniutto², Patrizia Burra³, Salvatore Gruttadauria⁴, Roberta Vella⁵, Silvia Martini⁶, Maria Cristina Morelli⁷, Gianluca Svegliati Baroni⁸, Giuseppe Marrone⁹, Francesca Romana Ponziani¹⁰, Paolo Caraceni¹¹, Paolo Angeli¹², Vincenza Calvaruso¹³, Valerio Giannelli¹⁴; Commission of Liver Transplantation of the Italian Association for the study of Liver Diseases (AISF)

Affiliations

¹ Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy.
² Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, University of Udine 33100, Udine, Italy. Electronic address: pierluigi.toniutto@uniud.it.
³ Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università Padova, Department of Surgery, Oncology and Gastroenterology, University of Padova 35122, Padova, Italy.
⁴ Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; University of Catania, Catania, Italy.
⁵ Department for the Treatment and the Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione), UPMCI (University of Pittsburgh Medical Center Italy) Palermo, Italy; Department of Precision Medicine in the Medical, Surgical and Critical Care Area University of Palermo, Palermo, Italy.
⁶ Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
⁷ RCCS Azienda Ospedaliero-Universitaria di Bologna, Internal Medicine Unit for the treatment of Severe Organ Failure, Bologna, Italy.
⁸ Liver Injury and Transplant Unit, Polytechnic University of Marche 60121 Ancona, Italy.
⁹ Liver Transplant Medicine Unit, Fondazione Policlinico Universitario Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
¹⁰ Hepatology Unit, CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.
¹¹ Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Semeiotics, IRCCS AOU Bologna, Bologna, Italy.
¹² Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy.
¹³ Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo 90127 Palermo, Italy.
¹⁴ Transplantation Department, San Camillo Hospital, Rome, Italy.

PMID: 39645428
DOI: 10.1016/j.dld.2024.11.006

Abstract

Hypoalbuminemia is a risk factor for mortality in patients with end-stage liver disease (ESLD) and in those undergoing orthotopic liver transplantation (OLT), since it represents a biomarker of post-operative delayed functional recovery of the graft. Despite albumin infusion during and after OLT is frequently adopted in recipients with hypoalbuminemia, it remains unclear whether this procedure could improve post OLT clinical outcomes. Observational studies indicated that treatment with albumin after OLT might be beneficial in reducing ascites and acute kidney injury (AKI) development. However, considering potential complications and the cost of albumin therapy, the decision to use albumin after OLT should be based on careful consideration of patient's individual needs and risks. In addition, the threshold plasma value of albumin below which it could be clinically useful to infuse albumin has not been clearly defined. This systematic review, prepared in accordance with the PRISMA 2020 guidelines, aimed to assess the efficacy of albumin infusion in patients undergoing OLT, in the prevention or treatment of ascites, AKI, and ischemia reperfusion syndrome, as well as its potential impact on patient survival. Furthermore, this review aimed to illustrate the pathophysiological bases justifying the use of albumin infusion in a subset of patients receiving OLT.

Keywords: Acute kidney injury; Albumin; Orthotopic liver transplantation; Systematic review.

Publication types

Review