Dear Editor, Liver transplantation (LT) is a promising treatment modality for patients with Wilson's disease (WD). 1 According to AASLD, the indication of LT for WD patients is acute liver failure or decompensated cirrhosis unresponsive to chelation treatment. 2 It is generally believed that LT can benefit patients with hepatic WD and also improve patients with severe neurological symptoms or mixed type WD, but the survival rate of the latter is lower than that of patients with simple hepatic WD. 3,4 And the efficacy and prognosis of LT in patients with neurological WD are always open to debate, 5-7 and we found that a patient with hepatic WD developed neurological symptoms less than a year after successfully receiving LT for acute liver failure at a young age, and that the patient's neurological symptoms continued to worsen over the next 6 years of regular follow-up and treatment. The findings suggest that we need to further explore the possible mechanisms underlying the neurological symptoms seen in WD after LT and propose improvements to the subsequent treatment regimen.An 18-year-old female patient was clinically diagnosed with WD at the age of 12 years according to the Leipzig score and was later confirmed by next-generation sequencing to carry pathogenic variants (p.R778L from father and p.R992L from mother) of two differ-