Direct adsorption of lipoproteins (DALI) from whole blood: First long-termclinical experience with a new LDL-apheresis system for the treatment of familial hypercholesterolaemia
M. Jansen et al., Direct adsorption of lipoproteins (DALI) from whole blood: First long-termclinical experience with a new LDL-apheresis system for the treatment of familial hypercholesterolaemia, WIEN KLIN W, 112(2), 2000, pp. 61-69
Background: The DALI (direct adsorption of lipoproteins) LDL-apheresis syst
em is a novel device for the removal of lipoproteins from whole blood.
Methods: We report the first long-term treatment experience (16.7 +/- 12.6
months; 57 +/- 43 treatments / patient) using different DALI adsorber sizes
(DALI-500, DALI-750, DALI-1000) in seven patients with homozygous (n =1) a
nd severe heterozygous familial hypercholesterolaemia. For each treatment,
1.6 fold of the calculated blood volume was processed. Treatments were sche
duled at weekly or two-weekly intervals.
Results: The smallest DALI-500 configuration was unable to achieve sufficie
nt removal of LDL cholesterol, with the adsorber being exhausted already at
desorption of 65% of the calculated blood volume. In contrast, both larger
adsorber systems effectively removed lipoproteins until the end of treatme
nt. Therefore, the DALI-750 device was used for long-term treatment.
LDL cholesterol (mean pretreatment value: 179 +/- 44 mg/dl) was reduced by
73.4 +/- 7.7% and Lp(a) levels (mean pretreatment value: 43 +/- 33 mg/dl) b
y 69.5 +/- 8.3%. HDL cholesterol (mean pretreatment value: 47 +/- 15 mg/dl)
was reduced by 16.3 +/- 8.0% during the treatment. In the long term, LDL c
holesterol was reduced by 54.0 +/- 10.5% - from 259 +/- 101 mg/dl to 119 +/
- 19 mg/dl.
No serious side effects occurred during the treatment. Long-term evaluation
of other laboratory parameters showed a reduction in haemoglobin due to tr
eatment-associated blood loss despite frequent iron supplementation.
Conclusion: Sufficient reductions in LDL cholesterol and Lp(a) were achieve
d using the DALI-750 system and the treatment was well tolerated. The easy
use and short period of 153 +/- 22 minutes required for each treatment are
the major advantages of the DALI system as compared to other available LDL-
apheresis devices. Potential particle release from the adsorber into the ci
rculation must be ruled out before the system can be introduced in clinical
routine.