Double Filtration Plasmapheresis (DFPP) in Severe Hypertriglyceridemia Patients - a Pilot Study

Severe hypertriglyceridemia (sHTG) is an independent risk factor of atherosclerotic heart disease (ASHD) and acute pancreatitis (AP). The aim was to evaluate the efficacy and safety of DFPP in sHTG patients (TG > 1,000 mg/dL).

This was a prospective single-center study in which patients with severe symptomatic drug and diet refractory HTG were recruited. Peripheral venous access of upper extremities was used for DFPP. Blood flow rate was 100 - 120 mL/min and plasma separation rate was 800 - 1,000 mL/h. Plasma volume to treat in each case was calculated with the Kaplan formula. Anticoagulation was achieved by low molecular weight heparin. Treatment goal was triglyceride level decreased to normal (< 1.7 mmol/L). Epidemiological data, lipid, hematological parameters as well as side effects were evaluated before and after DFPP.

Seven patients (6 males and 1 female) were consecutively enrolled to this trial. There was diabetes mellitus type 2 in four patients and obesity-associated nephropathy in one patient. The mean age was 42.5 years. The average TG level before plasmapheresis was 17.41 mmol/L (range 10.93 - 26.33 mmol/L). After one session, the levels of triglyceride, total cholesterol, LDL-c, HDL-c decreased significantly by 58.3%, 43.2%, 41.9%, 20.7%, respectively. The mean number of treatment sessions was 1.5 (range 1 - 3). DFPP was well-tolerated. Except for transient decrease of albumin, globulin and fibrinogen, liver and renal functions, hematological parameters did not change significantly.

According to our own experience, DFPP may be used safely and effectively in sHTG patients at risk of acute coronary events and AP. However, further randomized controlled trials are necessary to explore the long-term effect.