The Impact of Lipoprotein Apheresis on Changes in Biochemical Enzymes: A Systematic Review and Meta-Analysis

Lipoprotein apheresis (LA) is an established therapy for severe, drug-refractory dyslipidemias. Nevertheless, clinicians often monitor hepatic and muscle enzymes during treatment because transient biochemical shifts can be misinterpreted as injury. In this study, we synthesize the evidence on how repeated apheresis sessions affect circulating enzymes. We systematically searched PubMed, Scopus and Web of Science from inception to August 2025 for observational human studies reporting pre- and post-apheresis values (mean and SD) for aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), and creatine phosphokinase (CPK). Effects were expressed as weighted mean differences (WMD, IU/L). Of 267 records screened, 9 articles (published 1998-2006) met eligibility for quantitative synthesis, yielding 9 ALT, 8 AST, 7 ALP, 6 GGT, 9 LDH and 6 CPK study estimates. Pooled analyses showed significant decreases in AST (WMD = -0.87; 95% CI: -1.51 to -0.23; p = 0.007), ALP (WMD = -6.28; CI: -11.75to -0.80; p = 0.02), LDH (WMD = -11.12; CI: -17.01 to -5.24; p = 0.001) and CPK (WMD = -6.91; CI: -13.06 to -0.75; p = 0.02). However, levels of ALT (WMD = -0.78; CI: -2.10 to 0.53; p = 0.29) and GGT (WMD = -2.64; CI: -8.71 to 3.44; p = 0.39) were unchanged. Across repeated-session studies, LA does not elevate hepatic or muscle injury markers and is associated with modest reductions in AST, ALP, LDH, and CPK. These findings support the biochemical safety profile of apheresis and suggest that routine enzyme monitoring should be interpreted in context.