Therapeutic plasma exchange in patients with severe hypertriglyceridemia: a multicenter study.
Extremely high plasma triglyceride (TG) concentration is a recognized risk factor for acute pancreatitis (AP). In order to evaluate the therapeutic efficacy of plasma-exchange plasmapheresis in treating patients with severe hypertriglyceridemia (sHTG), 17 patients who had not responded to conventional medical therapy (fat-free diet plus pharmaceutical interventions) were referred for therapeutic plasma exchange (TPE) in a multicenter frame case series study. Two hundred seventeen TPE sessions were performed, and therapy is ongoing for five (30%) of the patients. After treatment, the mean plasma TG and total cholesterol concentrations were significantly reduced from 1929 and 510 mg/dL, to 762 and 227 mg/dL, respectively (P < or = 0.001 in both cases). In most cases, the interval between treatments was related to the clinical presentation and individual circumstances. The removal of TG-rich lipoproteins prevented relapses of AP. In this case series, TPE is confirmed as a safe and reliable method for treating patients with refractory sHTG when a severe complication, such as AP, is clinically demonstrated or can be actively prevented. Therefore, in cases where standard medical approaches fail to promote the clearance of TGs from plasma and a high risk of first or second hypertriglyceridemic pancreatitis persists, TPE provides a therapeutic option for preventing life-threatening sHTG.
Stefanutti
Claudia
C
University of Rome La Sapienza, Umberto I Hospital, Department of Clinical and Medical Therapy, Plasmapheresis Unit, Rome, Italy. cstefanutti@alice.it
Di Giacomo
Serafina
S
Vivenzio
Antonio
A
Labbadia
Giancarlo
G
Mazza
Fabio
F
D'Alessandri
Giovanna
G
Russi
Giampaolo
G
De Silvestro
Giustina
G
Marson
Piero
P
D000208:Acute Disease; D000328:Adult; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012008:Recurrence; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides; D002784:Cholesterol