Severe atherosclerosis of donor hepatic arteries is a salvageable condition in liver transplantation to optimise the graft utilisation: A case series and review of the literature

•We showed how to manage sever atherosclerosis in liver transplant with special technique.•This case report will help not to discard donated liver graft.•Management of sever artherosclerosis, liver transplantation. The presence of atherosclerosis of the common hepatic artery (CHA) in donor livers potentially contributes to vascular complications after liver transplantation, thereby most of those organs are traditionally discarded. Herein, we describe the successful outcome of three patients transplanted with grafts that had severe atherosclerosis of the donor CHA up to the level of the gastroduodenal artery (GDA). In all three cases, endarterectomies were performed by dissection between the atheromatous core and the artery intima using a dissecting spatula, allowing to secure the lumen of the vessel. The native CHA/GDA patch was aligned with the corresponding CHA/GDA patch from the graft for the arterial reconstruction. No vascular complications were seen post-operatively. Endarterectomy and anatomical reconstitution of the arterial tree, without any redundancy or kinking, allowed for the successful transplantation of organs that would be otherwise discarded. Further, the straight alignment of the arteries may enhance flow dynamics, preventing thrombosis. This report might guide future studies targeting means to increase the utility of donor livers discarded due to arterial atherosclerosis.