LDL-aferéza – zhodnocení výsledků 1000 provedených procedur

LDL apheresis – evaluation of the results from 1000 performed procedures

The aim of this study was to evaluate 1000 LDL-apheresis procedures performed in 9 patients with severe familial lipid disorder. LDL-apheresis is a method of extracorporeal elimination of LDL-cholesterol, based on immunoadsorption and used in severe hyperlipidemia patients, refractory to conventional treatment.

Materials and methods:
Blood cells separators Cobe Spectra (COBE BCT, USA) were used to separate patient’s plasma. Immunoadsorption was performed by means of ADA or Adasorb (Medicap, Germany) and columns LDL-Lipopak (Pocard Ltd., Russia). Before and immediately after the procedure, blood samples were taken and serum levels of lipoproteins tested.

Results:
the average period of treatment was 6.3 years, range 2.9 – 8.5. The number of aphereses performed per one patient was 111 ± 58. Average interval between two procedures was 18.9 ± 9.5 days. One procedure takes 3.8 ± 0.5 hours. Average volume of processed plasma was 6654 ± 968 ml, plasma volume per kilogram of body weight was 97 ± 26 ml/kg. Average plasma flow was 30 ± 4 ml/min, average blood flow 67.7 ± 5.4. The ACD-A: blood ratio 1:22 was used. The average flow of ACD-A was 3.1 ± 0.25 ml/min. Average ACD-A consumption per one apheresis procedure was 697 ± 118 ml. The average total cholesterol decrease was 70 ± 7%, LDL-cholesterol 84 ± 8%, HDL-cholesterol 26 ± 7% and triacylglycerides 56 ± 19% during one procedure. On the average 53.6 aphereses were performed per one pair of columns, range 11–109. One pair of columns was used on average 35.9 month. The adverse events were mostly mild and represented by vaso-vagal events and manifestations of citrate related toxicity.

Conclusion:
Our modification of immunoadsorption is effective, selective and safe.

Key words:
LDL-apheresis, familial hypercholesterolemia, immunoadsorption, effectivity, side-effects