Plasma exchange and heart–liver transplantation in a patient with homozygous familial hypercholesterolemia


Corresponding author: Jon Offstad, Department of Cardiology, Rikshospitalet, Sognsvannsveien 20, 0027 Oslo. Tel: +47 230 72014; fax number: +47 230 73917; e-mail:


A female patient born in 1950 underwent plasma exchange and concomitant drug therapy for 20 yr due to homozygous familial hypercholesterolemia. Plasma exchange reduced total cholesterol levels from 25–30 mmol/L (967–1160 mg/dL) before treatment to 9.5 mmol/L (363 mg/dL) with regression of xanthomas and no side effects of long-term treatment. Due to end-stage calcific left ventricular outflow tract obstruction not amenable to standard valve reconstructive surgery, a combined heart–liver transplantation was successfully performed in 1996. She is without symptoms and living a normal life 4 yr after transplantation. Total cholesterol value is normal (4.7 mmol/L [182 mg/dL]) using a moderate dose of statins. Selective coronary angiography is without signs of graft vascular disease and the liver function is normal.