Evaluation of Human Albumin Use in Liver Transplantation Setting: A Tertiary Health Care Hospital Experience

Abstract Background: Human albumin (HA) plays an crucial role in several body physiological paths, including inflammatory system, platelet aggregation, vasodilation, and acid/base balance. In severe liver cases such as liver cirrhosis, HA exposes to abnormalities in synthesis and effectiveness. Liver transplantation cases are accompanied by HA level and functional abnormalities pre-and postoperatively. The administration of intravenous HA could be necessitated in such clinical settings. Overutilization of HA is of significant concern due to the need for more unified consensus in clinical practice, leading to the presence of side effects and an increase in cost burden. The study evaluates the current utilization of HA in liver transplant settings and the adherence to the institutional guidelines with the calculation of the direct cost utilization among different transplant services in our center. Materials and Methods: This retrospective-prospective study included patients who had 70 HA course of therapy in total under any of three liver transplant services in a tertiary health-care center. The study evaluated the appropriateness of HA utilization according to adherence to the hospital-approved guidelines, addressing approved and unapproved indications, dosing, and duration of treatment when possible. The direct cost of HA utilization is calculated for adult liver transplant surgery, adult transplant hepatology, and pediatric liver transplant services. Results: Our results showed that HA utilization was (54%) for approved indications versus (46%) for unapproved indications in King Faisal Specialist Hospital and Research Center (KFSH&RC) guidelines. The highest usage for unapproved indication was 38% in controlling ascites and peripheral edema post-transplantation. No severe side effects were documented with HA utilization. However, HA use under the liver transplantation services leads to an annual direct cost of 273,028.04 Saudi Ryal (SAR). Conclusion: Our data support the need to re-evaluate the HA institutional guidelines and protocols to specify and include indications of pre-and post-transplant expected utilization considering updated literature and international best practice guidelines recommendations to control the permissiveness of uncensored HA prescriptions aiming for potential cost reduction.