International Position Statement on Use of human albumin for Liver Cirrhosis-related Coplications

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Position statement 1. HA infusion should be used for the differential diagnosis of HRS.

Position statement 2. HA infusion should be used for the management of HRS.

Position statement 3. HA infusion should be used for the prevention of PPCD in patients with liver cirrhosis and ascites undergoing LVP (>5 L). HA infusion could be considered in cirrhotic patients with acute on chronic liver failure (ACLF)/AKI undergoing paracentesis of <5 L.

Position statement 4. In the setting where budget and logistical issues can be resolved, long-term regular HA infusion can be used to improve ascites, prevent other complications of liver cirrhosis, and prolong survival in patients with uncomplicated ascites requiring diuretics.

Position statement 5. HA infusion should be used to prevent AKI and improve survival in cirrhotic patients with SBP, particularly those with baseline serum bilirubin ≥4 mg/dL or serum creatinine ≥1 mg/dL.

Position statement 6. HA infusion does not prevent renal impairment or improve survival in patients with cirrhosis affected by non-SBP infections other than septic shock.

Position statement 7. HA infusion may be considered for the management of overt HE, especially in patients with liver cirrhosis and hypoalbuminemia.

Position statement 8. HA infusion may be considered for the improvement of hyponatremia in cirrhotic patients, but its preventive effect should be further explored.

Position statement 9. More data are warranted to evaluate the use of HA to attenuate muscle cramps in patients with liver cirrhosis.

Position statement 10. HA may be considered for the management of cirrhotic patients with septic shock.

Position statement 11. Short-term HA infusion in general patients with acute decompensation of cirrhosis may not be beneficial. Further validation should be considered.

Position statement 12. HA infusion is generally safe, but may induce the development of pulmonary edema and severe allergic reactions.

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