Plasmapheresis for Hypertriglyceridemia-induced Acute Pancreatitis: A Systematic Review and Meta-summary of Case Reports

Background and aims: Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). However, the evidence on the management of hypertriglyceridemia-induced AP is lacking. We undertook a systematic review of all published case reports and series to evaluate the clinical characteristics of hypertriglyceridemia-induced AP patients in whom plasmapheresis was used, and the effect of plasmapheresis on plasma triglycerides levels and procedure-related safety. Materials and methods: A systematic literature search was performed for case reports and series published between January 1, 1975 and April 30, 2023 in PubMed, Science Direct, Embase and Google Scholar databases using keywords "hypertriglyceridemia" AND "pancreatitis" AND "plasmapheresis" OR "plasma exchange." The inclusion criteria were (1) hypertriglyceridemia-induced AP and (2) use of plasmapheresis to manage AP. Results: Seventy-one studies involving 91 unique patients were included in this meta-summary. Nearly three-fourth had severe AP and one-fifth with recurrent pancreatitis. A previous history of hypertriglyceridemia and diabetes was known in 52.7% of the patients, and alcohol abuse in 17.6%. The majority of the patients were young males, with 15 pregnant females. A median of two sessions with a plasma exchange volume of 3 L significantly reduced serum triglycerides in patients with hypertriglyceridemia. Most (96.7%) of the patients recovered with a median hospital and intensive care unit length of stay (LOS) of 11 and 5 days, respectively. Conclusion: Plasmapheresis is an effective therapeutic procedure that can significantly reduce triglycerides levels in hypertriglyceridemia-induced AP. The procedure is reasonably safe, including in patients with severe AP and pregnancy. Future prospective randomized studies are required to evaluate the impact of plasmapheresis on patient-centered outcomes compared with pharmacological management of AP. How to cite this article: Nasa P, Jain R, Singh O, Juneja D. Plasmapheresis for Hypertriglyceridemia-induced Acute Pancreatitis: A Systematic Review and Meta-summary of Case Reports. Indian J Crit Care Med 2025;29(7):604-611.