Albumin constitutes approximately one half of the
proteins in the plasma and plays a pivotal role in modulating the distribution of fluid between body compartments. Hence it is commonly employed in cirrhotic patients in association with
diuretics for the treatment of
ascites. Nevertheless, its usefulness is controversial in this condition and well-stated only in some circumstances. The item of safety of the
drug appears to be convincing due to the accurate cautions in the course of its preparation. Side effects are described in literature only as sporadic events. Indeed,
albumin administration is effective to prevent the circulatory dysfunctions after large-volume paracentesis and
renal failure and after Spontaneous Bacterial
Peritonitis (SBP). Finally
albumin represents, associated with
vasoconstrictors, the therapeutic gold standard for the
hepatorenal-syndrome (HRS). Physiopathological bases of the
therapeutic use of
albumin in
hepatic cirrhosis consist in both
hypoalbuminemia and
portal hypertension consequences. In fact, cirrhotic patient with
ascites, in spite of hydrosaline retention, shows an effective
hypovolemia with peripheral arterial vasodilatation and increase in heart rate. Therefore the effectiveness of
albumin administration in the treatment of
ascites is due to its plasma volume expander property as well as its efficacy in restoring plasmatic oncotic pressure. Trials are in progress in order to define the effectiveness of the prolonged home-administration of
human albumin in the treatment and prevention of
ascites. Finally, it has been recently demonstrated that the binding, transport and detoxification capacities of
human albumin are severely reduced in cirrhotics and this impairment correlates with the degree of
liver failure. Therefore, the next challenge will be to determine whether the alterations of non-oncotic properties of
albumin are able to forecast mortality in cirrhotics with
ascites and exogenous
albumin chronic administration will be effective in predicting and preventing such alterations.