AIM: To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications.METHODS: One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25g every two wk thereafter (group 1) or diuretics alone (group 2). The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications.RESULTS: Median follow-up was 84 (2-120) mo. Albumin-treated patients had significantly greater cumulative survival rate (Breslow test= 7.05, P= 0.0078) and lower probability of ascites recurrence (51% versus 94%,P＜0.0001). Chronic albumin infusion resulted in a mean increase in survival of 16 mo.CONCLUSION: Long-term albumin administration after first-onset ascites significantly improves patients' survival and decreases the risk of ascites recurrence.