title: The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: A systematic review.
abstract: BACKGROUND
  Mostly published as case reports or series, the role of apheresis in hypertriglyceridemia (HTG)-related acute pancreatitis (AP) remains unclear. We performed a systematic review of available literature on this topic with specific focus on disease severity.
  
  
  METHODS
  A search of electronic databases (PubMed, EMBASE, Cochrane) and gray literature yielded 5020 articles of which 74 met criteria for inclusion (301 unique patients). Relevant data were abstracted from full manuscripts and analyzed.
  
  
  RESULTS
  Most patients were young (mean age 37.9 ± 10.4 years) and male (71.5%). About two-thirds (69.7%) received apheresis within 48 h and most required only 1 or 2 sessions (84.4%). Apheresis resulted in an average reduction of serum TG by 85.4% (p < 0.001). There was high variability in reporting the presence of and criteria to define severe AP (reported 221/301, 73.4%; present 85/221, 38.5%) or organ failure (reported 104/301, 34.6%; present 52/104, 50.0%). Improvement was reported in the majority of patients (reported 144/301, 47.8%, present 136/144, 94.4%) mainly by clinical symptoms or laboratory tests. Overall mortality was 7.1% (21/294) which increased to 11.8% (10/85) with severe AP and 19.2% (10/52) with organ failure.
  
  
  CONCLUSIONS
  Apheresis effectively reduces serum TG levels. However, due to uncontrolled data, reporting bias and lack of a comparison group, definitive conclusions on the efficacy of apheresis in reducing AP severity cannot be made. We propose which patients may be best suitable for apheresis, type of studies needed and outcome measures to be studied in order to provide empiric data on the role of apheresis in HTG-related AP.
authors: Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Benjamin
authors: B
authors: Click
authors: Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Andrea M
authors: AM
authors: Ketchum
authors: Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Rose
authors: R
authors: Turner
authors: Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: David C
authors: DC
authors: Whitcomb
authors: Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Georgios I
authors: GI
authors: Papachristou
authors: Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: yadavd@upmc.edu.
authors: Dhiraj
authors: D
authors: Yadav
mesh_terms: D000328:Adult; D000368:Aged; D001781:Blood Component Removal / Q000379:methods*; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000628:therapy*
keywords: Hyperlipidemia; Hypertriglyceridemia; Pancreatitis; Plasma exchange; Plasmapheresis; Severity