Publication Name	World Journal of Transplantation
Manuscript ID	117975
Country	United States

Category	Anesthesiology
Manuscript Type	Case Report
Article Title	Bronchobiliary fistula in fibrolamellar hepatocellular carcinoma with anesthetic challenges during living donor liver transplantation: A case report
Manuscript Source	Invited Manuscript
All Author List	Andrea Gomez-Sanchez, Ibtesam A. Hilmi, Christopher B Hughes and Dahye Park
Funding Agency and Grant Number
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
Key Words	Fibrolamellar hepatocellular carcinoma; Bronchobiliary fistula; Liver transplantation; Anesthetic management; One-lung ventilation; Airway management; Hypoxic pulmonary vasoconstriction; Hepatopulmonary syndrome; Case report
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.
Citation	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; In press

Received	2025-12-22 08:13
Peer-Review Started	2025-12-22 08:13
First Decision by Editorial Office Director	2026-01-19 08:50
Return for Revision	2026-01-19 08:50
Revised	2026-02-03 13:13
Publication Fee Transferred
Second Decision by Editor	2026-02-25 02:36
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-02-25 07:50
Articles in Press	2026-02-25 07:50
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-3230 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Copyright	©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com