Published case reports, systematic reviews, and forensic literature documenting kratom‑associated cholestatic hepatitis, liver failure, and transplantation.
Systematic review of 32 published cases: predominantly cholestatic injury, 4 progressed to liver transplantation. Kratom causes severe, sometimes irreversible liver damage.
Read Review →Review of 20 cases; majority cholestatic, some requiring liver transplant. Highlights unpredictable hepatotoxicity even at low doses.
Read Review →Comprehensive review of in vitro, in vivo, and case study toxicities including hepatotoxicity, nephrotoxicity, and cardiotoxicity.
Read Review →Total bilirubin 70.6 mg/dL – highest reported. Plasma exchange saved the patient. Kratom can cause catastrophic liver failure.
Read Case →Patient with jaundice and total bilirubin 10.7 mg/dL after 3 weeks of kratom. Injury resolved only after cessation.
Read Case →High‑dose kratom (30 g/day) caused bilirubin 34.3 mg/dL and perivenular necrosis on biopsy. RUCAM score 6 (probable).
Read Case →ALT 1635, AST 642, bilirubin 10.6 mg/dL after 2 weeks of kratom cocktail. RUCAM score 7 (probable).
Read Case →Low‑dose kratom (3 g total) produced jaundice and severe cholestasis. Even small amounts can trigger injury.
Read Case →Peak bilirubin 28.9 mg/dL after 2 months of kratom use. Severe cholestatic hepatitis confirmed by biopsy.
Read Case →30‑year‑old with ALT 1057, AST 332, total bilirubin 6.7 mg/dL after 2 weeks kratom. Normalized after discontinuation.
Read Case →47‑year‑old with mixed liver injury after 3 weeks kratom. Positive rechallenge with shorter latency. RUCAM score +9 (highly probable).
Read Case →Case report of kratom‑induced seizures and elevated liver enzymes, highlighting hepatotoxicity.
Read Case →Liver biopsy showing cholestatic injury and bile duct damage.
Read Case →Patient re‑challenged after recovery and developed liver injury again – confirming causality.
Read Case →Mixed liver injury, kidney failure requiring dialysis, colitis. Required liver transplantation and remains on dialysis.
Read Case →32‑year‑old developed severe cholestatic liver injury (CIOMS 8, highly probable). Authors conclude kratom has “potentially lethal side effects”.
Read Report →38‑year‑old with AST 173, ALT 586 after chronic kratom use. Highlights need for liver monitoring.
Read Case →36‑year‑old consumed >500g kratom; AST 1347, ALT 3717, renal injury. Required 14 days ICU.
Read Case →Kratom‑associated liver injury typically presents as cholestatic or mixed hepatocellular‑cholestatic hepatitis. Common symptoms include jaundice, pruritus, dark urine, abdominal pain, nausea, and fatigue. Laboratory abnormalities include elevated bilirubin (often >10 mg/dL), alkaline phosphatase, and transaminases (AST/ALT). Latency from kratom initiation to injury ranges from days to months; rechallenge can produce rapid recurrence. Severe cases have progressed to acute liver failure, requiring intensive care, plasma exchange, or liver transplantation. The FDA has issued multiple warnings regarding hepatotoxicity, and poison center surveillance continues to identify liver injury cases.
Clinicians should consider kratom exposure in the differential diagnosis of unexplained cholestatic or mixed liver injury, especially in patients who use herbal supplements. Routine toxicology screens do not detect kratom alkaloids – directed history is essential.
