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The ALBA study explored expert clinical perspectives, barriers, and current practices regarding long\u2010term albumin therapy in Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A two\u2010round national Delphi study was conducted among 47 hepatology experts from Spanish hospitals with broad geographic coverage. The survey included 40 Delphi statements and 14 items on opinion, attitude, and behaviour across five domains. Consensus was defined as Tastle's coefficient \u2265\u20090.8. Items with moderate consensus (0.7\u20130.79) and &lt;\u200970% agreement, or &lt;\u20090.7, were re\u2010evaluated in round two.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Long\u2010term albumin was reportedly used in 25.5% of centers. However, panellists broadly supported its potential benefit in preventing ascites\u2010related complications and endorsed its use regardless of transplant eligibility. It was prioritised for patients with difficult\u2010to\u2010control ascites (89.3%) and renal impairment (55.2%), though benefits were perceived as lower in late\u2010stage disease. Day hospitals were seen as the most appropriate setting, despite strain. Main barriers included evidentiary limitations, institutional logistics, and pharmacy restrictions. Therapy was viewed as overall safe, with dose\u2010dependent cardiac risk, and considered cost\u2010effective. Strong support was expressed for a national registry to guide implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Panellists considered long\u2010term albumin administration to be clinically beneficial and prioritised its use for patients with advanced\u2010stage disease, regardless of transplant candidacy. However, integration into routine practice remains limited due to a lack of robust supporting evidence, along with institutional and logistical barriers. A national registry and targeted strategies to optimise use and resource allocation were endorsed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70429","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:31:03Z","timestamp":1763037063000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Perspectives on Long\u2010Term Albumin Therapy in Decompensated Cirrhosis: A Nationwide Delphi Survey in Spain\u2014The\n                    <scp>ALBA<\/scp>\n                    Study"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-9445","authenticated-orcid":false,"given":"Jose Ignacio","family":"Fortea","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL) Marqu\u00e9s de Valdecilla University Hospital  Santander Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4470-7724","authenticated-orcid":false,"given":"Diego Rincon","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"CIBERehd  Madrid Spain"},{"name":"Departamento de Medicina Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9131-2592","authenticated-orcid":false,"given":"Agust\u00edn","family":"Albillos","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS, CIBERehd, Universidad de Alcal\u00e1  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa Sol\u00e1","family":"Verg\u00e9s","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-8437","authenticated-orcid":false,"given":"Rafael","family":"Ba\u00f1ares","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital General Universitario Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n  Madrid Spain"},{"name":"CIBERehd  Madrid Spain"},{"name":"Departamento de Medicina Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.03.005"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000521"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-321790"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2022.100708"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.022"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-023-10536-7"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2021.06.021"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2023.10.016"},{"issue":"1","key":"e_1_2_13_12_1","first-page":"14","article-title":"Portal Hypertension: Recommendations for Diagnosis and Treatment. 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