Long-term albumin infusion in decompensated cirrhosis: A review of current literature

Table 1 Characteristics of studies on long-term albumin infusion in decompensated cirrhosis patients

No	Ref.	Country	Study design	Follow-up duration1	Study population	Exclusion criteria	Duration of albumin infusion (d)	Sample size	Child-Pugh Score (A/B/C)	MELD score (albumin vs SMT)1	Intervention	Control
1	Wilkinson and Sherlock[70], 1962	England	Single centre, non-randomized	22 mo	Cirrhosis patients with ascites despite 6 wk of dietary and diuretic therapy	HCC	616	16	NA	NA	Albumin 25-100 g until serum colloid oncotic pressure 38-40 cm of water	SMT
2	Gentilini et al[71], 1999	Italy	Single centre, randomised controlled trial	3 yr	Adult cirrhosis patients with ascites after 1 wk of bed rest and low sodium diet	Renal or cardiac failure, HCC or other malignancies, HE (grades 2-4), infections, gastrointestinal bleeding or DIVC	1095	126	0/67/59	NA	Albumin 12.5 g/d	SMT
3	Romanelli et al[72], 2006	Italy	Single centre, randomised controlled trial	84 mo (2-120)	Adult cirrhosis patients with ascites	Active alcohol abuse; previous ascites (grades 2 and 3) or HE; cardiac, respiratory or renal impairment; diabetes; refractory ascites; HCC or other malignancies; gastrointestinal bleeding; infections or DIVC	1440	100	0/46/54	NA	Albumin 25 g weekly in the first year, 25 g every two weeks thereafter	SMT
4	Caraceni et al[11], 2018	Italy	Multicentre, randomised controlled trial	18 mo	Adult cirrhosis patients with medically controlled uncomplicated ascites	Refractory ascites, recent decompensation, TIPS, HCC, liver transplantation, ongoing alcohol abuse, extrahepatic organ failure and albumin use for the treatment of ascites within one month	540	431	64/282/85	12 (10–15), 13 (10–16)	Albumin 40 g twice weekly for 2 wk, and 40 g weekly up to 18 mo	SMT
5	Sola-Vera et al[40], 2003	Spain	Multicentre, randomised controlled trial	1 yr	Cirrhotic patients with ascites on the liver transplantation waiting list	Arterial hypertension; treatment with psychotropic drugs or antibiotic; TIPS; cardiac or respiratory failure; previous or currently listed for liver transplant; HIV or HCV infection, contraindications to midodrine	365	196	NIL	16 ± 6.2, 17 ± 6.0,	Midodrine 15-30 mg/d and Albumin 40 g/15 d for 1 yr	SMT
6	Di Pascoli et al[13], 2019	Italy	Non-randomised, prospective study	Mean 408 +/- 394 d	Adult cirrhosis patients with refractory ascites	HCC beyond Milan criteria or severe extrahepatic diseases	720	70	CTP 9.3 ± 1.7; 9.5 ± 1.6	15.2 ± 5.4, 14.9 ± 5	Human albumin 20 grams twice per week	SMT, LVP when indicated
7	China et al[75], 2018	United Kingdom	Multicentre randomised controlled trial	6 mo	Adult cirrhosis patients hospitalised with acute decompensation and hypoalbuminemia (serum albumin < 30 g/L)	Advanced HCC; heart failure	14	828	NA	NA	Albumin 20-80 g/d until serum albumin ≥ 35 g/L	SMT

¹Presented in mean (± SD) or median (interquartile range).

SMT: Standard medical therapy, HCC: Hepatocellular carcinoma; HE: Hepatic encephalopathy; DIVC: Disseminated intravascular coagulopathy; TIPS: Transjugular intrahepatic portosystemic shunt; LVP: Large-volume paracentesis; NA: Not available; NIL: Nanoimprint lithography; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; CTP: Cytoplasmic transduction peptide.