Acute liver failure temporally associated with intensive consumption of Plantago major tea: A case report

Table 2 Serial laboratory findings before and after liver transplantation

Date/clinical phase	AST (U/L)	ALT (U/L)	ALP (U/L)	GGT (U/L)	Total bilirubin (mg/dL)	INR	Creatinine (mg/dL)	Ammonia or lactate, when relevant
July 2, 2024/first complete pre-LT panel	370	338	194	322	14.41	2.111	0.30	Ammonia 146 μmol/L
July 3, 2024/pre-LT	300	307	228	317	14.10	1.92	0.39	Lactate 4.52 mmol/L
July 4, 2024/pre-LT	284	282	202	301	12.41	1.95	0.40	Lactate 3.40 mmol/L
July 5, 2024/POD1	2044	1325	121	326	10.00	1.75	0.40	Lactate 3.65 mmol/L
July 10, 2024/POD6	101	387	135	358	2.79	1.05	0.43	Lactate 1.60 mmol/L
August 9, 2024/early recovery	40	55	81	132	0.97	0.99	0.70	-
January 21, 2025/stable graft function	23	27	-	23	0.30	1.01	-	-
March 14, 2025/graft dysfunction	731	877	327	428	8.10	-	0.48	-
April 22, 2025/persistent rejection/cholestasis	172	397	258	851	17.20	-	0.62	-
May 13, 2025/persistent graft dysfunction	117	193	192	501	14.90	-	0.57	-
July 29, 2025/recovery after intensified treatment	127	245	-	986	1.63	-	0.54	-
September 1, 2026/most recent follow-up	31	35	95	88	0.39	1.08	0.72	-

¹On July 2, 2024, INR was 2.11 in the selected first complete panel and subsequently reached 2.27. The R factor for the July 2, 2024 panel was 6.27, calculated as (alanine aminotransferase/upper limit of normal)/(alkaline phosphatase/upper limit of normal) = (338/35)/(194/126), indicating a hepatocellular pattern. The July 2, 2024 pre-liver transplantation panel is the first complete panel available for retrospective review and may not represent the true biochemical peak of the initial suspected herb-induced injury. Early post-transplant aminotransferase elevations reflect graft-related postoperative changes and are not the peak of the initial suspected herb-induced injury. Em dashes indicate that the variable was not measured or was not available at that time. LT: Liver transplantation; POD: Postoperative day; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transferase; INR: International normalized ratio.