Albumin in Advanced Liver Diseases: The Good and Bad of a Drug!

Authors: Jagdish RK; Maras, JS; Sarin, SK.

Affiliations: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India; Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.

Publication: Hepatology; 2021 April

Abstract: Human serum albumin (HSA) is the most abundant plasma protein, and it regulates diverse body functions. In advanced and decompensated cirrhosis patients, serum albumin levels are low due to reduction in hepatocyte mass and loss due to disease per se and multiple therapeutic interventions. Due to its oncotic and non-oncotic properties, administration of human albumin solutions (HAS) has been found to be beneficial in patients undergoing large volume paracentesis, hepatorenal syndrome and spontaneous bacterial peritonitis. Albumin also improves functionality of the immune cells and mitigates the severity and risks of infections in advanced cirrhosis. Its long-term administration can modify the course of decompensated cirrhosis patients by reducing the onset of new complications, improving quality of life with probable survival benefits. There is, however, a need to rationalize the dose, duration, frequency of albumin therapy in different liver diseases and stages of cirrhosis. In acute-on chronic liver failure patients, potentially toxic oxidized isoforms of albumin increase substantially, especially human nonmercaptalbumin1 (HNA1) or 2(HNA2) and nitroso-albumin. The role of HAS administration in such patients is unclear. Whether removal of the pathological and dysfunctional albumin forms in these patients by albumin dialysis is helpful, requires additional studies. Use of albumin is not without adverse events. These include allergic and transfusion reactions, volume overload, antibody formation, coagulation derangements, etc. Considering its cost, limited availability, need of health care setting for its administration, and potential adverse effects; judicious use of HAS in liver diseases is advocated. There is a need of new albumin molecules and economic alternatives in hepatology practice.