Gomez-Sanchez A, Hilmi IA, Hughes CB, Park D. Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report. World J Transplant 2026; 16(2): 117975 [DOI: 10.5500/wjt.v16.i2.117975]
Corresponding Author of This Article
Dahye Park, MD, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 200 Lothrop Steet, Pittsburgh, PA 15213, United States. dahye.md@gmail.com
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Anesthesiology
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case-report
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Gomez-Sanchez A, Hilmi IA, Hughes CB, Park D. Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report. World J Transplant 2026; 16(2): 117975 [DOI: 10.5500/wjt.v16.i2.117975]
World J Transplant. Jun 18, 2026; 16(2): 117975 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.117975
Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report
Andrea Gomez-Sanchez, Ibtesam A Hilmi, Christopher B Hughes, Dahye Park
Andrea Gomez-Sanchez, Ibtesam A Hilmi, Dahye Park, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Christopher B Hughes, Department of Surgery, Abdominal transplantation Division, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Author contributions: Gomez-Sanchez A, Hilmi IA, Park D conceptualized the study; Sanchez AG, Park D collected and analyzed the data, literature review, and wrote the manuscript; Hughes CB provided detailed input on the surgical procedure; All authors have read and approved the final manuscript.
AI contribution statement: This manuscript was not generated by AI. The author wrote the main body. Only ChatGPT was used to assist in condensing the introduction and conclusion sections to meet the word count requirements. The AI tool was employed for language polishing and grammar review.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Dahye Park, MD, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 200 Lothrop Steet, Pittsburgh, PA 15213, United States. dahye.md@gmail.com
Received: December 22, 2025 Revised: February 3, 2026 Accepted: February 25, 2026 Published online: June 18, 2026 Processing time: 159 Days and 17.6 Hours
Core Tip
Core Tip: Bronchobiliary fistula in a patient with fibrolamellar hepatocellular carcinoma creates major anesthetic challenges during liver transplantation, particularly when one-lung ventilation is not tolerated. In this case, despite successful lung isolation with a double-lumen tube, one-lung ventilation resulted in hypoxemia, likely due to impaired pulmonary physiology related to chronic liver disease, prior lung surgery, and thoracic radiation. Ventilation therefore had to be transitioned to two-lung ventilation with continuous airway suctioning to control persistent biliary contamination. The operation was further complicated by extensive thoracoabdominal adhesions and significant blood loss, requiring early vascular access planning and rapid, high-volume transfusion. This case highlights the importance of understanding altered hypoxic pulmonary vasoconstriction and ventilation-perfusion mismatch in liver disease, anticipating potential failure of one-lung ventilation, and preparing flexible airway, ventilation, and transfusion strategies to maintain oxygenation and hemodynamic stability during complex liver transplantation.
