Saliba, F., Bañares, R., Larsen, F.S. et al.
Intensive Care Med 48, 1352–1367 (2022).
The present narrative review on albumin dialysis provides
evidence-based and expert opinion guidelines for clinicians caring for adult
patients with different types of liver failure. The review was prepared by an
expert panel of 13 members with liver and intensive care expertise in
extracorporeal liver support therapies for the management of patients with
liver failure. The coordinating committee developed the questions according to
their importance in the management of patients with liver failure. For each
indication, experts conducted a comprehensive review of the literature aiming
to identify the best available evidence and assessed the quality of evidence
based on the literature and their experience. Summary statements and expert’s
recommendations covered all indications of albumin dialysis therapy in patients
with liver failure, timing and intensity of treatment, efficacy, technical
issues related to the device and safety. The panel supports the data from the
literature that albumin dialysis showed a beneficial effect on hepatic
encephalopathy, refractory pruritus, renal function, reduction of cholestasis
and jaundice. However, the trials lacked to show a clear beneficial effect on
overall survival. A short-term survival benefit at 15 and 21 days respectively
in acute and acute-on-chronic liver failure has been reported in recent
studies. The technique should be limited to patients with a transplant project,
to centers experienced in the management of advanced liver disease. The use of
extracorporeal albumin dialysis could be beneficial in selected patients with
advanced liver diseases listed for transplant or with a transplant project.
Waiting future large randomized controlled trials, this panel experts’
statements may help careful patient selection and better treatment modalities.
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