Background: Acute severe pancreatitis is associated with high morbidity and mortality. Hypertriglyceridemia is the third most common cause of acute pancreatitis and higher triglyceride levels increase the risk for severe acute pancreatitis. Plasma exchange is an effective treatment method to lower triglycerides. Our study aimed to investigate the efficiency of plasma exchange as a treatment option for acute hypertriglyceridemia-induced pancreatitis (HTGP), the impact on mortality assessed by the SOFA-, SAPS II-, BISAP Score, Ranson's, and Glasgow-Imrie Criteria as well as the overall length of stay in hospital and ICU.Methods: In this retrospective single-center cohort study, triglycerides before and after plasma exchange were compared. SOFA and SAPS II were taken on ICU admission and at discharge. To further characterize the patient cohort, BISAP Score (on admission), Ranson's Criteria (on admission and after 48 hours), and the Glasgow-Imrie Criteria (48 hours after admission) were calculated.Results: The study included 11 patients (91 % male; median age 45 years). Triglycerides were reduced from 4266 +/- 3560.6 to 842 +/- 575.9 mg/dl during plasmapheresis (P < .001). The median ICU length of stay was 3 +/- 4.2 days. In-hospital mortality was 0 %. The SOFA score was significantly reduced from 4 +/- 3.4 points on admission to 2 +/- 2.1 points at discharge (P = .017). Triglycerides and cholesterol decreased from 3126 +/- 3665 to 531 +/- 273 mg/dl (P = .003) and from 438 +/- 137.9 to 222 +/- 59.5 mg/dl (P = .028), respectively. Conclusion: Plasmapheresis is an efficient and safe treatment method for ICU patients with acute HTGP and significantly reduces triglycerides. Furthermore, plasmapheresis significantly improves the clinical outcomes of patients with HTGP.