Comparison of plasma separation using centrifugation or filtration for MONET lipoprotein apheresis in patients with cardiovascular disease and severe dyslipidemia

Abstract

Introduction: Homozygous or severe heterozygous familial hypercholesterolemia and elevated lipoprotein(a) levels may be treated with membrane filtration. The MONET system (Fresenius Medical Care, Bad Homburg, Germany) involves plasma separation by centrifugation or filtration.

Methods: Whether the method of plasma separation affects lipoprotein lowering and treatment safety was investigated in a single-center retrospective study.

Results: The centrifugation-based plasma separation achieved a higher plasma flow and shorter time to treat 1 L of plasma (46.2 ± 8.6 min), than the filtration-based system (71.5 ± 40.0 min; p = 0.001). The mean reduction of LDL-cholesterol was 69% and 67% with centrifugation and filtration and was 75% for lipoprotein(a) with both plasma separation methods. A reduction of IgM by more than 60%, of albumin and total protein by approximately 20% and low frequency of side effects was observed.

Conclusions: The efficacy of lowering atherogenic lipoproteins was comparable with both plasma separation methods. Centrifugation was more time-efficient compared to filtration.

Keywords: LDL cholesterol; Lp(a); lipoprotein apheresis; plasma separation.

FIGURE 1

Reduction rates of lipids after lipoprotein apheresis with plasma centrifugation (COM.TEC) (n = 14, Lp(a): n = 11) and plasma filtration (Art Universal) (n = 12, Lp(a): n = 9)

FIGURE 2

Safety laboratory parameters after lipoprotein apheresis with plasma centrifugation (COM.TEC) and plasma filtration (Art Universal) (hemoglobin, erythrocytes, thrombocytes, leukocytes: n = 14/12 [COM.TEC/Art Universal], IgA, IgG, albumin, total protein: n = 10/11, IgM: n = 9/11), given as hematocrit (Hct) corrected value relative to the pretreatment value; *p < 0.05 COM.TEC vs. Art Universal system, Mann–Whitney U test