AISF-SIMTI position paper on the appropriate use of albumin in patients with liver cirrhosis: a 2020 update

Since the publication in 2016 of the recommendations on the appropriate use of albumin in patients with liver cirrhosis endorsed by the Italian Association for the Study of the Liver (AISF) and the Italian Association of Transfusion Medicine and Immunohematology (SIMTI)1,2, a considerable amount of pathophysiological and clinical data have been collected on the long-term administration of human albumin in decompensated cirrhosis. Considering the potential impact of these novel results on daily clinical practice, which will likely lead to an increase in the demand for human albumin, and taking into account the limited availability of this blood product, the two scientific associations nominated a panel of experts to review the available clinical literature and produce new practical clinical recommendations for the long-term use of human albumin in patients with decompensated cirrhosis. The level of evidence and strength of recommendation were judged according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system3. The strength of the evidence has been classified into three levels: high, moderate, and low quality, while that of the recommendation has been divided into two: strong and weak. Where there is no clear evidence, the recommendations are based on the consensus advice of the writing committee and the expert opinion(s) reported in the literature.