Patient 2 (P2) was a 44-year-old man who underwent OLT for acute-on-chronic liver failure (ACLF). The patient had chronic hepatitis B for several years and received irregular treatment. During the transplant operation, the patient suffered severe post-reperfusion syndrome (PRS) due to hyperkalemia, that is, cardiac arrest after reperfusion. After cardiopulmonary resuscitation, the heartbeat and circulation returned to normal levels. Nevertheless, the initial recovery from transplantation was excellent, and there were no early operation-related complications. Intraoperative immune induction and postoperative baseline immunosuppression were the same as those in Patient 1. One week after transplantation, the patient exhibited a consciousness disorder, mainly manifested as unclear content of consciousness, loss of orientation, calculation ability, and logical ability. The vital signs were stable, except for a slight fever, with a maximum temperature of 38.0 C. Brain magnetic resonance imaging (MRI) revealed two abnormal signals in the left temporal lobe and right frontal lobe, and the possibility of infection was considered (Figure 2A). CSF routine, biochemistry, and culture also showed no abnormalities, but NGS confirmed an invasive Aspergillus infection in the CSF. Based on these guidelines, voriconazole was selected as the antifungal therapy. Meanwhile, the dosage of tacrolimus was adjusted to maintain the concentration below 8 ng/ml. After three weeks of antifungal treatment, the patient's neurological symptoms slightly improved, but re-examination of brain MRI showed that the lesion was larger than before (Figure 2B). A second NGS of the CSF showed Candida, but no Aspergillus. After multidisciplinary consultation and discussion, a biopsy was performed to confirm the pathology; however, the patient and his family refused to do so. Considering the antifungal effect of sirolimus, immunosuppression was adjusted to sirolimus monotherapy for maintenance therapy. Meanwhile, fluconazole was added for antifungal therapy and the plasma concentration was maintained between 4.5 mg/mL and 5.5 mg/mL. After 2 weeks of combined treatment, re-examination of brain MRI showed that the lesions did not increase significantly, and the neurological symptoms were significantly improved. During the following three weeks, antifungal therapy was maintained, and re-examination of the brain MRI showed that the infected lesions were smaller than before (Figure 2C). Immunosuppression was gradually restored by tacrolimus combined with sirolimus. After comprehensive treatment, the patient recovered well and was discharged three months after liver transplantation.