Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey

Abstract

Background/Aims: Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis. In patients with severe HTG (TG level>1000 mg/dL), it may be beneficial to immediately lower the levels of triglyceride (TG) and chylomicrons. In this study, we present one of the largest case series on the use of therapeutic plasma exchange (TPE) for hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Materials and Methods: Overall, 33 patients who were admitted to our clinic for HTG-AP and underwent TPE between January 2007 and July 2017 were included in the study. Clinical data and outcomes and the reduction of triglyceride levels were examined retrospectively. Results: The TG level decreased by 54.4%, and the total cholesterol level decreased by 52.1% after one TPE session. The TG decrease after the second TPE session was found to be 79.4%. There were 20 (60.6%) patients with mild acute pancreatitis, 10 (30.3%) patients with moderetaly severe acute pancreatitis, and 3 (9.1%) patients with severe acute pancreatitis based on the categorization according to the revised Atlanta criteria. Regarding local complications, the acute peripancreatic fluid collection was observed in 13 (39.4%) patients, acute necrotic collection was observed in 1 (3%) patient, walled-off necrosis was observed in 1 (3%) patient, and pancreatic pseudocyst was not observed in any patient. Mortality was not determined in patients with mild and moderately severe acute pancreatitis, and its rate was 33.3% in patients with severe acute pancreatitis. The overall mortality rate was 3%. No significant complications related to TPE were noted. Conclusion: TPE is a safe and helpful therapeutic treatment method for patients with HTG-AP and may be considered particularly in patients with severe acute pancreatitis.

Whole exome sequencing identifies three novel gene mutations in patients with the triad of diabetic ketoacidosis, hypertriglyceridemia, and acute pancreatitis

“…This is a safe, effective, and inexpensive first‐line therapy for hypertriglyceridemia‐associated AP. Plasmapheresis can be used to clear the triglycerides, which has been described as a treatment option for hypertriglyceridemia‐induced AP with early therapy associated with improved outcomes 41 . The six patients reported in this study have received insulin, DKA therapy, and plasmapheresis that helped control their symptoms.…”

“…Plasmapheresis can be used to clear the triglycerides, which has been described as a treatment option for hypertriglyceridemia-induced AP with early therapy associated with improved outcomes. 41 The six patients reported in this study have received insulin, DKA therapy, and plasmapheresis that helped control their symptoms. Previous studies have used insulin and hydration therapy in nine patients, but only three patients (3/9) underwent plasmapheresis.…”

Relapsing and Progressive Complications of Severe Hypertriglyceridemia: Effective Long-Term Treatment with Double Filtration Plasmapheresis

“…Clinical studies are sparse. Plasma exchange and DFPP have also been found to be safe and effective for the emergency treatment of severe HTG-AP during pregnancy [6,[18][19][20][21][22][23][24][25][26][27][28]. Shortening of hospitalization was reported as a major benefit [23,29].…”

PPAR-Alpha Agonist Fenofibrate Combined with Octreotide Acetate in the Treatment of Acute Hyperlipidemia Pancreatitis

“…Criteria. Inclusion criteria were as follows: (1) The time from onset to hospital admission is less than 48 h, and the medical history, clinical manifestations, serological indicators, and CT examination of the upper abdomen all meet the relevant diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2014 Edition). (2) The patient is diagnosed with hyperlipidemia: TG > 11:3 mmol/l or TG of 5.65~11.3 mmol/l, and the serum is chylous.…”

“…According to statistics, the incidence of hypertriglyceridemia in the social population is increasing year by year, and the diseased population is showing a younger trend. The disorder of primary or secondary lipoprotein metabolism structure further leads to the occurrence of acute pancreatitis, which becomes an important pathogenic factor after stones and alcohol consumption [1]. It is reported that the incidence of pancreatitis in patients with hypertriglyceridemia accounts for about 15% to 20% [2].…”