Therapeutic plasma exchange for the management of hypertriglyceridemia-induced acute pancreatitis

Abstract

<b>BACKGROUND:</b> Hypertriglyceridemia (HTG) is the third-most important cause of acute pancreatitis (AP) and its early diagnosis is essential to prevent AP-associated morbidity and mortality. Therapeutic plasma exchange (TPE) is a promising treatment option for improving patient outcomes and prognosis in HTG-induced AP (HTG-AP). <b>OBJECTIVE:</b> This study assessed the severity of disease in patients with HTG-AP and evaluated the therapeutic effects, safety, and procedural challenges of TPE in its management. <b>METHODS:</b> Patients with HTG-AP, diagnosed according to the Atlanta classification, and exhibiting serum triglyceride (TG) concentrations ≥11.3 mmol/L were included in the study. Consenting patients received TPE using the PRISMAFLEX^® system (TPE group), and the remaining were treated in accordance with the guidelines of Vietnam's Ministry of Health, 2015 (non-TPE group). The duration of hospital or intensive care unit (ICU) stay in patients and mortality rates were compared between the TPE and non-TPE groups. The reduction in serum TG levels was also evaluated in the TPE group. <b>RESULTS:</b> This prospective study included 165 patients with HTG-AP (<i>n</i> = 83, TPE group; <i>n</i> = 82, non-TPE group). The mean age of the patients was 41.0 ± 9.3 years. The duration of hospital and ICU stay was significantly lower in the TPE group compared to that of the non-TPE group (<i>P</i> < 0.05). A significant reduction in TG levels over baseline was noted in patients who received TPE (77%; <i>P</i> < 0.05), which was observed after the first TPE session (70.81%; <i>P</i> < 0.05). <b>CONCLUSION:</b> TPE using the PRISMAFLEX^® system is safe and well-tolerated in patients with HTG-AP and is associated with minimal technical constraints.