Herbal medicines
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Acute liver transplant rejection: case report A 54-year-old female liver transplant recipient developed acute transplant rejection during treatment with a herbal supplement containing alfalfa [Green Food Complex]. The woman had undergone liver transplantation 6 years earlier for liver failure due to suspected drug toxicity. She had been stable on mycophenolate mofetil and sirolimus for almost 6 years when she was hospitalised with a 2-week history of jaundice. Laboratory findings revealed an AST level of 2379 IU/L, an ALT level of 1109 IU/L, an ALP level of 979 IU/L and a total bilirubin level of 18 mg/dL with direct bilirubin 12 mg/dL. Scleral icterus was observed on examination. Liver biopsy demonstrated stage 4 cirrhosis with vascular steatosis and acute-on-chronic rejection. Further questioning revealed the use of Green Food Complex, a herbal supplement containing alfalfa and other herbal medicines since 2006. She reported increasing her dose recently to boost her immune system [route, dosage and duration of treatment to reaction onset not stated]. The woman was started on methylprednisolone sodium succinate, and subsequently transitioned to prednisone. Within 20 days of admission, her transaminase levels had improved. Her hospital course was further complicated by deep vein thrombosis, pulmonary oedema, line infection and respiratory failure leading to death. Author comment: "It was theorized that the alfalfa in Green Food Complex might stimulate her immune system causing rejection in transplanted organ." Gao C, et al. To be Green or not to be Green, That is the Question: A Case of Acute Liver Rejection in a Post Transplant Patient:. 75th Annual Scientific Meeting of the American College of Gastroenterology : abstr. P1034, 15 Oct 2010. 803043119 Available from: URL: http://www.acg.gi.org - USA
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Reactions 30 Oct 2010 No. 1325
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