26 years of LDL--apheresis: a review of experience

Since 1981, when LDL-Apheresis was introduced into the clinical routine at the University of Cologne as the first and so far only Apoprotein B specific LDL-cholesterol elimination technique, considerable experience has since then accumulated and has changed not only the operational technique but also extended the indications, the optimation of the target values, the introduction of supportive cholesterol lowering drug therapy, considerations of the potential pleiotropic mechanisms and the introduction of a quality control supported electronic data processing. Mild to moderate side effects range between 3% and 4.5%, whereas serious undesired reactions did not occur within 26 years with more than 80,000 treatments performed at Cologne and considerably more world wide. As cholesterol can nowadays be widely eliminated in patients with familial hypercholesterolaemia (FH), the focus of consideration should be more directed to the treatment of additional risk factors. Thus, centres of competence, providing for more than the ability to technically reduce cholesterol may be desirable. Whereas numerous diagnostic procedures exist to demonstrate the value of cholesterol lowering therapies, the prolongation of survival as demonstrated in 7 homozygous and 29 heterozygous FH patients and in 5 patients with end stage disease appears to be the most convincing evidence for the value of LDL-Apheresis. Due to the repetitive cycling and re-use LDL-Apheresis is furthermore not only the most efficient but also the most economic approach to extracorporeal LDL-elimination therapy.