Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia

Background Severe hypertriglyceridemia (HTG) leads to major complications such as acute pancreatitis. Lipoprotein apheresis has been proposed as a therapeutic tool for decreasing triglyceride levels, although experience is limited. Objective To describe our experience with double filtration plasmapheresis (DFPP) in patients with severe HTG and pancreatitis in the plasmapheresis unit of a tertiary hospital in Spain. Methods We recruited 4 patients with severe HTG (triglycerides [TGs] >1000 mg/dL) and acute pancreatitis. All the patients underwent DFPP as part of their treatment. Epidemiologic and laboratory data were collected before and after each plasmapheresis session. Results The average TG level before plasmapheresis was 3136 mg/dL (35.44 mmol/L; range, 1306–6693 mg/dL, 14.76–75.63 mmol/L), and the average Acute Physiology And Chronic Health Evaluation (APACHE) II level before the first session was 6 (range, 3–8). All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis. The mean number of sessions was 2.1 (range, 1–3), and mean TG level after plasmapheresis was 428 mg/dL (4.84 mmol/L; range, 169–515 mg/dL; 1.91–5.82 mmol/L). After the first session, the mean decrease in TG levels was 69.16% (2169 mg/dL, range, 945–5925 mg/dL; 24.51 mmol/L, range, 10.78–66.95 mmol/L), and after the last session, TG levels fell by 89.09% (2794 mg/dL, range, 945–6198 mg/dL; 31.57 mmol/L, range, 10.68–70.04 mmol/L). None of the patients developed complications related to plasmapheresis. Conclusions According to available evidence and our own experience, DFPP can be an effective and rapid treatment option in patients with severe HTG and complications. However, further research, including randomized controlled studies, is necessary.