Use Of Albumin Infusions Research Articles

The incidence and natural history of ascites after liver transplantation.

Ascites is common in cirrhosis but uncommon after liver transplant. We aimed to characterize the incidence, natural history, and current management strategies of post-transplant ascites. We performed a retrospective cohort study of patients who underwent liver transplantation at 2 centers. We included patients who underwent deceased donor whole graft liver transplants between 2002 and 2019. Chart review identified patients with post-transplant ascites, requiring a paracentesis between 1 and 6-month post-transplants. Detailed chart review identified clinical and transplant characteristics, evaluation of ascites etiology, and treatments. Of 1591 patients who successfully underwent a first-time orthotopic liver transplant for chronic liver disease, 101 (6.3%) developed post-transplant ascites. Only 62% of these patients required large volume paracentesis for ascites before transplant. 36% of patients with post-transplant ascites had early allograft dysfunction. Most patients with post-transplant ascites (73%) required a paracentesis within 2 months of transplant, but 27% had delayed ascites onset. From 2002 to 2019, ascites studies were obtained less often, and hepatic vein pressure measurement was performed more often. Diuretics were the mainstay of treatment (58%). The use of albumin infusion and splenic artery embolization to treat post-transplant ascites increased over time. Larger pre-transplant spleen size was associated with a greater number of post-transplant paracenteses (r=0.32 and p=0.003). For patients who underwent splenic intervention, paracentesis frequency was significantly reduced (1.6-0.4 paracenteses/month, p=0.0001). The majority (72%) of patients had clinical resolution of their ascites at 6-month post-transplant. Persistent or recurrent ascites continues to be a clinical issue in the modern era of liver transplantation. Most had clinical resolution within 6 months, some requiring intervention.

Effectiveness of albumin infusion in the management of hyponatremia in decompensated cirrhosis: a systematic review and meta-analysis

Background and Aim: Hyponatraemia portends a poor prognosis in decompensated cirrhosis and is an independent predictor of mortality. Multiple modalities have been evaluated in the management of hyponatremia, including albumin infusion. However, the effect of albumin infusion in the resolution of hyponatremia is unclear. We conducted a systematic review to explore the available literature on the use of albumin infusion in hyponatremia. Methods: We performed a comprehensive search using MEDLINE and EMBASE for studies reporting the effectiveness of albumin infusion in the resolution of hyponatremia. All available studies on adult patients published in the English language investigating the impact of albumin infusion of any dose, administration frequency, and duration of therapy were included. The study protocol was prospectively registered (CRD42021245914) Results: The literature search yielded 1473 references after duplicate removal. Only four studies (two cohort studies, one case series and one randomized trial) satisfied the predefined selection criteria after a full-text review. While hyponatremia was clearly defined as serum sodium <130meEq/L in all studies, only one study explicitly defined hyponatremia resolution (serum sodium >135mEq/L). No differentiation was made between the type of hyponatremia. The strength of albumin infusion used was 5 % and 20%. All but one study reported significant improvement of hyponatremia with albumin infusion. A subgroup analysis showed albumin infusion improved 30-day survival (Odds ratio 0.43, 95% CI 0.25-0.74, I2=0.) No studies reported adverse events or impact of concomitant associations ( diuretic withawal, lactulose use, sepsis). Conclusion: The available evidence for the use of albumin infusion for the resolution of hyponatremia is insufficient. Large prospective studies with pre-defined selection criteria and endpoints are required to generate the evidence

Effect of albumin administration on post-operation mortality, duration on ventilator, and hospital stay on patients in cardiac intensive care: An observational study

Purpose: To justify the use of albumin infusion in patients in post-surgery cardiac intensive care unit.&#x0D; Methods: All patients who were hemodynamically stable before the operation and admitted into the surgical intensive care unit following coronary artery bypass, cardiopulmonary bypass, or aortic surgery, had no excessive postoperative bleeding and not on diuretic treatment, were included in the analysis. A total of 1998 patients were divided into two cohorts, viz, the first group was placed on albumin infusion (n = 999) while the second group received normal saline infusion (n = 999). Data were obtained from DICOM files of patients and records of pharmacy. Wilcoxon test or two-tailed paired t-test followed by Tukey post-hoc tests were performed for statistical analysis at 95 % of confidence level.&#x0D; Results: Albumin and normal saline administration did not decrease the duration of mechanical ventilation, incidence of mechanical ventilation, need for blood transfusion, and length of hospital stay (p &gt; 0.05). Albumin infusion decreased the need for fresh frozen plasma transfusion from 85 to 67, reduced mortality (p = 0.0005, q = 3.959), lowered serum lactate level (p &lt; 0.0001, q = 43.853), but increased cardiac index (p &lt; 0.0001, q = 12.192) as well as financial burden (p &lt; 0.0001, q = 95.158) for the patients, compared to normal saline group.&#x0D; Conclusion: In view of the foregoing, it is recommended that the use of restriction of albumin resuscitation in surgical intensive care unit should be restricted in this subset of patients evluated in this study.

Tolvaptan reduces the required amount of albumin infusion in patients with decompensated cirrhosis with uncontrolled ascites : a multicenter retrospective propensity score-matched cohort study

Background : The aim of this retrospective study was to determine whether tolvaptan treatment reduces the amount of albumin administered, volume of ascites removed, and frequency of paracentesis procedures in patients with decompensated cirrhosis with uncontrolled ascites with conventional diuretics. Patients and methods : The control (C) group included patients treated with conventional diuretics. The tolvaptan (T) group included patients treated with both tolvaptan and conventional diuretics. Both groups were matched according to baseline parameters. The amount of albumin administered, volume of ascites removed, and frequency of paracentesis within 30 days of onset of uncontrolled ascites were compared between the two groups. Results : After matching, 74 patients (C=37, T=37) were included. Baseline parameters (C vs. T group) were as follows : age, 69.5 ± 9.3 vs. 70.4 ± 11.0 years (p = 0.702) ; males, 24 (64.9%) vs. 25 (67.6%) (p = 0.999) ; patients with hepatocellular carcinoma, 17 (45.9%) vs. 18 (48.6%) (p = 0.999) ; serum albumin levels at treatment initiation, 2.76 ± 0.48 vs. 2.73 ± 0.49 g/dL (p = 0.773), and serum creatinine levels at treatment initiation, 1.18 ± 1.23 vs. 1.09 ± 0.48 g/dL (p = 0.679). In the C vs. T groups, respectively, mean amount of albumin administered was 51.0 ± 31.4 vs. 33.4 ± 29.8 g/month (p = 0.016) ; mean volume of ascites removed was 2,905 ± 4,921 vs. 1,824 ± 3,185 mL/month (p = 0.266) ; and mean frequency of paracentesis was 0.92 ± 1.46 vs. 0.89 ± 1.45 procedures (p = 0.937). Conclusions : Tolvaptan reduced the use of albumin infusion in patients with decompensated cirrhosis and was effective and acceptable for uncontrolled ascites.

PO-0326 Comprehensive Analysis Of Exchange Transfusions Performed Over A 6yr Period In A Tertiary Neonatal Intensive Care Unit: Abstract PO-0326 Table 1

<h3>Introduction</h3> In the 1940’s, exchange transfusion (ExT) was introduced to help decrease the morbidity and mortality associated with haemolytic disease of the newborn (HDN) and prevent kernicterus. ExT was subsequently applied to other causes of neonatal hyperbiliribinaemia, severe neonatal anaemia from a variety of causes, some non-immune hydrops cases, Neonatal metabolic conditions such as hyperammonaemia, severe hyperkalaemia and neonatal haemochromatosis. In the 1970’s when ExT was exclusively used for the management of HDN, Lucey <i><i>et al</i>,</i> predicted a decrease in frequency of this procedure for HDN in future. Complications were estimated to increase due to the lack or decreased frequency of ExT with time. <h3>Objectives</h3> To determine. Number of ET done over a 6 yr period. Patients demographics, time of ExT, Indications. Number of Babies who have had Inutero ExT. Maternal details: Blood group, antibodies. The level of bilirubin at which transfusion took place. Prior treatment pre-ExT: In-utero Tx, Intravenous Immunoglobulin (IVIG) use; use of albumin infusion. The ExT-related complications: Any complication not present prior to the ET which occurred within 48 hrs after the ET: Defined as follows- platelet count &lt;150, hypocalaemia, ionised Calcium &lt;0.8, fits, raised INR. <h3>Methods</h3> Setting: Level 3 NICU. Retrospective notes review of patients who underwent ExT. January 2008–March 2014 (6.25 yrs). Exclusion criteria: Those for which notes were not obtained. <h3>Results</h3> Total admissions to the NICU over the period = 5,000. Number of exchange transfusions done= 15 in 14 patients. 0.3% of admissions over the period. Table of cases. Total number of request made to the Blood transfusion department for blood product for exchange. <h3>Conclusion</h3> Average ExT/yr in a Level 3 NICU = 2.4/yr. ExT is currently being used for a variety of causes. There were no complications related to the procedure itself. Complications post-ExT were all biochemical (hypocalcaemia- in 13 cases) or haematologic (low platelets 13 cases) Use of IVIG: Given pre-Ext to all ABO, Rh cases except 2 and to the Non-immune hydrops secondary to Parvovirus. 1st documented case of ExT use in hyperbilirubinaemia secondary to accidental Hyperlipidaemia from TPN-Lipid infusion and Haemolysis with Anaemia post-Octenisan wash treatment for MRSA-colonisation treatment in a preterm baby.

Albumin infusion for low serum albumin in preterm newborn infants.

Intravenous albumin infusion to treat hypoalbuminaemia is used in intensive care nurseries. Hypoalbuminaemia occurs in a number of clinical situations including prematurity, the acutely unwell infant, respiratory distress syndrome (RDS), chronic lung disease (CLD), necrotising enterocolitis (NEC), intracranial haemorrhage, hydrops fetalis and oedema. Fluid overload is a potential side effect of albumin administration. Albumin is a blood product and therefore carries the potential risk of infection and adverse reactions. Albumin is also a scarce and expensive resource. The primary objective was to assess whether albumin infusions, in preterm neonates with low serum albumin, reduces mortality and morbidity. A secondary objective was to assess whether albumin infusion is associated with significant side effects. Searches were made of MEDLINE from 1966 to April 2004, CINAHL from 1982 to April 2004 and the current Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 1, 2004). Previous reviews (including cross references) and abstracts were also searched. All randomised controlled trials in which individual patients were allocated to albumin infusion versus control were included. Cross-over studies were excluded. Quasi randomised trials were excluded. Participants were preterm infants who had hypoalbuminaemia. Types of interventions included albumin infusion versus placebo (e.g. crystalloid) or no treatment. The reviewers worked independently to search for trials for inclusion and to assess methodological quality. Studies were assessed using the following key criteria: blinding of randomisation, blinding of intervention, completeness of follow up and blinding of outcome measurement. Only two small studies were found for inclusion in this review and only one reported clinically relevant outcomes - it found no significant differences for our primary outcome measure of death (RR 1.5 [95% confidence interval 0.3 - 7.43]) or secondary outcome measures of intraventricular haemorrhage, patent ductus arteriosus, necrotising enterocolitis, bronchopulmonary dysplasia, duration of mechanical ventilation and duration of oxygen therapy. There is a lack of evidence from randomised trials to determine whether the routine use of albumin infusion, in preterm neonates with low serum albumin, reduces mortality or morbidity, and no evidence to assess whether albumin infusion is associated with significant side effects. There is a need for good quality, double-blind randomised controlled trials to assess the safety and efficacy of albumin infusions in preterm neonates with low serum albumin.

Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review.

The effectiveness of human albumin administration in prevention of severe ovarian hyperstimulation syndrome (OHSS) was reviewed using the Cochrane Menstrual Disorders and Subfertility Group literature search strategy. Only randomized controlled trials (RCT) comparing the effect of human albumin with placebo or no treatment were included in this review. Seven RCT were identified, five of which met our inclusion criteria and enrolled 378 women (193 in the albumin-treated group and 185 in the control group). Trials under consideration were evaluated for methodological quality and appropriateness for inclusion without consideration of their results. The five included trials were single-centre parallel RCT. Relevant data were extracted independently by two reviewers using the standardized data extraction sheet. Validity was assessed in terms of method of randomization, completeness of follow-up, presence or absence of crossover and co-intervention. There was significant reduction in severe OHSS on administration of human albumin [odds ratio (OR): 0.28; 95% confidence interval (95% CI) 0.11-0.73]. Relative risk was 0.35 (95% CI 0.14-0.87) and absolute risk reduction was 5.5. For every 18 women at risk of severe OHSS, albumin infusion will save one more case. There was no evidence of an increase in the pregnancy rate [OR 1.09 (95% CI 0.65-1.83)]. This Cochrane review shows a clear benefit from administration of i.v. albumin at the time of oocyte retrieval in prevention of severe OHSS in high-risk cases. Whether the number needed to treat would justify the routine use of albumin infusion in cases at risk of severe OHSS needs to be judged by clinical decision-makers.

Intra-venous albumin for preventing severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that occurs after the administration of human menopausal gonadotrophin (hMG) with or without gonadotrophin releasing hormone (GnRH) agonists. OHSS is a threat to every woman undergoing ovulation induction and is potentially lethal in its severest form. Severe OHSS is characterised by growth of multiple large follicles with massive extravascular protein rich fluid shift. This may lead to hypovolaemia, haemoconcentration, oliguria, and electrolyte disturbance. Human albumin solutions are now used in the management of shock and other conditions in which restoration of blood volume is urgent, the acute management of burns, and clinical situations associated with hypoproteinaemia. Recently, a number of clinical trials with conflicting results have been reported in which albumin has been tested as a possible way for preventing the severe form of OHSS. To review the effectiveness of human albumin administration in prevention of severe ovarian hyperstimulation syndrome. The Menstrual Disorders and Subfertility Group literature search strategy was used to identify randomised trials that had compared the use of human albumin with placebo or no treatment in the prevention of severe ovarian hyperstimulation syndrome. A diverse search strategy was employed, including handsearching of core journals from 1966 to the present, searching bibliographies of relevant trials, MEDLINE, EMBASE, PsychLIT and CINAHL databases, the MDSG specialised register, abstracts from North American and European meetings and contact with authors of relevant papers. Trials were included if they compared the effect of human albumin with placebo or no treatment on relevant outcomes. Only randomised controlled studies were included in this review. Trials under consideration were evaluated for methodological quality and appropriateness for inclusion without consideration of their results. Relevant data were extracted independently by two reviewers using the standardized data extraction sheet. Validity was assessed in terms of method of randomization, completeness of follow-up, presence or absence of crossover and co-intervention. 2x2 tables were generated for all relevant outcomes. Odds ratios were calculated using the Peto modified Mantel-Haenszel technique. Meta-analysis of the three included trials demonstrated significant reduction in severe ovarian hyperstimulation syndrome on administration of human albumin (common odds ratio 0.1, 95% confidence interval 0.03 to 0.39). There was no evidence of an increase in the pregnancy rate (common odds ratio 1.69, 95% confidence interval 0.7 to 4.07). This review shows a clear benefit from administration of intra-venous albumin at the time of oocyte retrieval in prevention of severe OHSS in high-risk cases. However, the results of this review can not be regarded as conclusive as they are based on only three small trials. Further trials are urgently needed.

LARGE VOLUME PARACENTESIS IN THE MANAGEMENT OF ASCITES IN THE PEDIATRIC POPULATION

86 Large volume paracentesis (LVP) has been evaluated for both therapeutic and diagnostic purposes in the management of ascites in cirrhotic adults. However, there are no published data relating to the safety, efficacy or methods of LVP in children. Our aim in this study was to characterize our experience in LVP for management of liver-disease associated ascites. Methods: Retrospective chart review was performed of 13 LVP sessions in 4 children with liver disease and tense ascites that did not respond to other measures. LVP was defined as removal of ≥ 10 cc/kg. Data reviewed included the volume and duration of LVP, use of ultrasound guidance, needle type, complications, use of i.v. albumin, ascitic fluid analysis and coagulation status of patients. Results: Patients were 4 children (ages 6 months to 17 years) with portal hypertension from chronic liver allograft rejection, Budd-Chiari syndrome, congenital hepatic fibrosis, or cirrhosis after trisegmentectomy for hepatoblastoma. Mean volume removed was 4572 ± 3015 ml (mean ± SD) or 76.1 ± 47.02 cc/kg over 5.5 ± 3.1 hours by a 16 gauge angiocath needle in 12 sessions and a 15 gauge Caldwell paracentesis needle in 1. Nine LVP's (69%) were ultrasound guided. Ascitic absolute neutrophil count was > 250/mm3 in 5 (39%). Cultures were negative in all, but 4 (31%) were treated for spontaneous bacterial peritonitis. I.V. albumin (mean dose 0.9 gm/kg) was given in 11 (85%) during LVP. Prothrombin time was normal in 1 patient (9%), 1-5 seconds above normal in 4 patients (36%), and > 5 seconds above normal in 6 patients (55%). Four patients (31%) received FFP prior to LVP. Complications encountered were hypotension in 1 (8%) and decreased urine output in 2 (15%); no significant hemorrhage was observed. Conclusions: LVP is a safe and effective therapeutic modality for managing tense abdominal ascites in children. Hypotension and decreased urine output were complications rarely encountered and were readily managed with volume expansion. The use of albumin infusion, the need to correct coagulopathy, and new needles specifically designed for LVP in children require further investigation.

Iso-oncotic volume expansion in the nephrotic syndrome.

1. In previous studies we found that albumin infusions caused only a modest natriuresis in the nephrotic syndrome, suggesting that hypovolaemia played no part in the sodium retention of these patients. However, this finding was inconclusive, since the hyperoncocity of the infused albumin probably opposed sodium excretion. 2. In the present study, we examined the effect of sustained (68 h) plasma volume expansion (+18%), by means of iso-oncotic albumin infusions, on renal function, blood pressure, humoral factors and sodium balance. 3. Plasma atrial natriuretic peptide levels increased almost threefold and renin-angiotensin system activity was suppressed. Glomerular filtration rate remained unchanged, whereas estimated renal plasma flow increased, resulting in a further decrease in filtration fraction. 4. The increase in plasma volume expansion was accompanied by a modest increase in sodium excretion, which, however, was less than the amount of sodium daily infused with the albumin solutions and consumed with the diet, so that net sodium was retained. 5. This observation supports the concept that an intrinsic renal defect causes the sodium retention in the nephrotic syndrome, and argues against the therapeutic use of albumin infusions.

Albumin Infusion Does not Alter the Intervillous Blood Flow in Severe Pre‐Eclampsia

Intervillous blood flow (IVBF) was measured by the 133Xe intravenous method before and after a 100 ml infusion of 20% human albumin in 13 cases of severe pre-eclampsia. In spite of the significant increase in serum albumin and colloid osmotic pressure values, no parallel direction of change in IVBF values could be seen to result from the immediate effects of volume expansion therapy. The results suggest that the use of albumin infusion is of no specific value in the treatment of severe pre-eclampsia in terms of evaluation at the level of placental circulation. The observation of an increase in placental blood flow in cases of real hypoalbuminemia calls for a further elucidation.

Membranous glomerulonephropathy with tubular dysfunction and linear tubular basement membrane IgG deposition

patient's condition progressed to end-stage renal disease. The decline in GFR was coincident with the development of poorly responsive and eventually severe and nonresponsive proteinuria. Glomerular damage and proteinuria may be causally related or independently related to another primary factor. We suggest that the proteinuric state might have been a causative factor in the progression of the mesangial sclerosis and glomerular capillary damage; there is experimental and clinical evidence to support such a causal relationship. Heavy proteinuria induced in rats by the injection of protein is associated with the development of focal glomerulosclerosis. 8' 9 These histologic changes are partially, and the functional changes completely, reversed when injections are discontinued? Fivesixths nephrectomy in the rat, with the accompanying increase in single nephron glomerular filtration and solute excretion, produces focal segmental glomerulosclerosis. 1~ The equivalent of these changes in the remnant kidney is seen in children with oligomeganephronia, a form of severe hypoplasia leading to renal insufficiency, and in children left with a marked decrease in GFR following relief of obstructive uropathy. All of these observations suggest that a large increase in the excretion of protein or other solute per nephron (functional overload) can lead to progressive glomerular sclerosis as was observed in our patient. If the degree of proteinuria is important in determining progressive glomerular damage, efforts to decrease the rate of protein excretion, including cytotoxic drugs, should be considered in patients with the most severe and persistent proteinuria. Unfortunately, no clear benefit has been shown for such therapy in patients with histologic patterns other than minimal lesion disease. Further, overly vigorous use of albumin infusions, together with diuretics, can produce increased protein excretion and lead potentially to epithelial Cell damage and mesangial sclerosis. The patient with the nephrotic syndrome described here developed end-stage renal disease after 18 years of steroidresponsive relapses, over which time there were 40 relapses, each responding to prednisone with disappearance of proteinuria. When resistance to steroid therapy developed, the renal histology was focal segmental glomerulosclerosis. We suggest that repeated episodes of heavy proteinuria were a factor in the development of the renal pathologic changes. REFERENCES