Double filtration plasmapheresis (DFPP) in the treatment of severe HTG and familial hypercholesterolemia (HoFH): A retrospective single-center experience

Background: Severe hypertriglyceridemia (sHTG) is the major cause of acute or relapsing pancreatitis（HTGP）, and extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) are always associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In addition to pharmacological therapy, double filtration plasmapheresis (DFPP) is recommended as an adjuvant treatment for reducing triglyceride (TG) levels in sHTG patients or diagnosed poorly pharmacologically controlled HoFH patients. Currently, data on the use of DFPP are limited. Purpose: To evaluate the efficacy and safety of sHTG and HoFH patients treated with double filtration plasmapheresis (DFPP). Material: and Method We implemented a retrospective observational study of a total of 18 patients with sHTG (TGs greater than 1000 mg/dl; 11.3 mmol/l or diagnosed poorly pharmacology-controlled HoFH) at West China Hospital. All patients received DFPP treatment during their hospitalization period. Result: A total of 18 patients, of whom 10 (55.6%) were male and 8 (44.4%) were female, were included. Fourteen (77.8%) patients were diagnosed with sHTG (including 10 severe HTGP, 3 severe sHTG, 1 glycogen storage diseasetype Ia (DNA test) and 4 homozygous FH (HoFH). The mean number of sessions was 1 (range, 1–3). The average TG level before plasmapheresis was 15.20 mmol/L (range, 0.77–141.00 mmol/L), and the average TG level after plasmapheresis was 2.55 mmol/L (range, 0.58–7.73 mmol/L). The average LDL-C level before plasmapheresis was 3.36 mmol/L (range, 0.14–13.96 mmol/L), and the average LDL-C level after plasmapheresis was 1.42mmol/L (range, 0.14–3.39 mmol/L). The percentage reductions intriglyceride, total cholesterol, low-density lipoprotein-C, and high-density lipoprotein-C levels were 83.2%, 77.1%, 57.7%, and -41.4%, respectively. No patient developed DFPP-associated complications. Conclusion: DFPP is an effective and safe approach for sHTG and HoFH patients. However, further investigation in randomized controlled trials or high-quality prospective studies is warranted to validate the present findings.