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BACKGROUND: Acute liver failure (ALF) involves a rapidly emerging impairment of liver function carrying a high mortality. Phenprocoumoninduced hepatotoxicity is a rare but potentially serious complication of oral-anticoagulation. As liver transplantation should be considered only for patients with unfavourable prognosis, there is further need to improve prognostic scoring systems. CASE PRESENTATION: This report is about a 68 year-old woman with phenprocoumon-induced ALF. Patient’s King’s College criteria and the dynamic assessment of liver function by plasma disappearance rate of indocyanine green (ICG-PDR) indicated a poor prognosis for spontaneous recovery. Transplantation was performed 8 days after admission and patient made a complete recovery. CONCLUSION: Considering the high mortality of ALF and organ shortage, current available models like King’s College criteria fail to adequately predict patients outcome. The dynamic liver evaluation by non-invasive ICG-PDR measurement might improve the appreciation of spontaneous recovery or candidacy for transplantation. Key Words: Acute liver failure (ALF); Indo-cyanine green (ICG); Plasma disappearance rate (PDR); Phenprocoumon-induced hepatotoxicity
