BACKGROUND Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare malignancy that may lead to complex postoperative complications, including brochobiliary fistula (BBF). CASE SUMMARY We report a 21-year-old patient with pulmonary metastatic FL-HCC, previously treated with multiple liver ablations, left lung wedge resections, and thoracic radiation, who subsequently developed a right-sided BBF. The patient presented for living donor liver transplantation after persistent bilioptysis and recurr