Therapeutic plasma exchange in hypertriglyceridemia-induced acute pancreatitis: A narrative review of indications, timing, and clinical outcomes

Abstract

Hypertriglyceridemia (HTG) is the third leading cause of acute pancreatitis (AP) and is associated with considerable morbidity and mortality. Rapid triglyceride (TG) reduction is a central component of treatment for hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Therapeutic plasma exchange (TPE) has been increasingly applied in HTG-AP, and recent studies have further evaluated its clinical value. This narrative review adheres to the Scale for the Assessment of Narrative Review Articles (SANRA). Relevant databases were searched to identify eligible randomized controlled trials, retrospective studies, case series and clinical guidelines regarding HTG-AP management. This analysis indicates that TPE can rapidly lower plasma TG levels and may be most useful in severe HTG-AP patients with organ dysfunction and markedly elevated TG levels. However, the available evidence is mainly retrospective and heterogeneous. Its effect on hard clinical outcomes, optimal timing, patient selection, and treatment protocols therefore remain uncertain. Further high-quality studies are needed to standardize TPE protocols and confirm its clinical benefits. This review summarizes current evidence to help clinicians optimize the use of TPE in the management of HTG-AP.