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Effectiveness of magnesium isoglycyrrhizinate on perioperative hepatic function protection in patients undergoing hepatectomy
Zhi-Qin Xie, Jin-Xing Wei, Jin-Yi Zhong, Xuan Luo, Hong-Kai Zhuang, Xiao-Wu Ma, Qing-Bin Wang, Wen-Liang Tan, Bing-Kun Wang, Ya-Jin Chen, Chuan-Jiang Li, Chang-Zhen Shang
Zhi-Qin Xie, Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan Province, China
Jin-Xing Wei, Jin-Yi Zhong, Xuan Luo, Hong-Kai Zhuang, Xiao-Wu Ma, Qing-Bin Wang, Bing-Kun Wang, Ya-Jin Chen, Chang-Zhen Shang, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Wen-Liang Tan, Department of Hepatobiliary and Pancreatic Surgery, Medical Center of Digestive Diseases, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
Chuan-Jiang Li, Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Co-first authors: Zhi-Qin Xie and Jin-Xing Wei.
Co-corresponding authors: Chuan-Jiang Li and Chang-Zhen Shang.
Author contributions: Xie ZQ, Wei JX, Zhong JY contributed to conceptualization, data curation, formal analysis, methodology, resources and writing-original draft; Luo X, Zhuang HK, Ma XW, Wang QB, Tan WL and Wang BW contributed to data curation; Chen YJ and Shang CZ contributed to conceptualization, resources, funding acquisition and writing, review and editing; Li CJ contributed to conceptualization, resources, and writing, review and editing; all authors approved the final version, and agree to be accountable for all aspects of the work.
Supported by the National Natural Science Foundation of China, No. 82573407; Basic and Applied Basic Research Foundation of Guangdong Province, No. 2023A1515220211; and the Furong Plan Health High Level Talent Project of Hunan Province, No. 20250924-1015.
Institutional review board statement: The study protocol was approved by the Medical Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (No. SYSKY-2023-1199-01) and Medical Ethics Committee of NanFang Hospital of Southern Medical University (No. NFEC-2024-051).
Informed consent statement: The study protocol was approved by the local ethics committee or institutional review board of each participating center. Patient consent was not required given the retrospective nature of the study. Protocols, data storage, and data use were compliant with international data privacy laws.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data are not publicly available due to restrictions for their containing information that could compromise the privacy of research patients.
Corresponding author: Chang-Zhen Shang, MD, Professor, Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 33 Yingfeng Road, Haizhu District, Guangzhou 510120, Guangdong Province, China.
shchzh2@mail.sysu.edu.cn
Received: November 14, 2025
Revised: January 13, 2026
Accepted: February 26, 2026
Published online: May 21, 2026
Processing time: 186 Days and 20 Hours
BACKGROUND
Real-world data remain limited on the effectiveness of magnesium isoglycyrrhizinate (MgIG) for post hepatectomy liver injury. We hypothesize that perioperative MgIG is effective as a management strategy against hepatic injury in patients undergoing hepatectomy.
AIM
To evaluate the prophylactic and therapeutic effectiveness of MgIG for hepatic injury in patients undergoing hepatectomy in a real-world setting.
METHODS
We retrospectively reviewed the clinical data of consecutive Chinese patients who underwent hepatectomy between March 2020 and March 2023 at two tertiary care hospitals in China. The cohorts were balanced using propensity score matching (PSM). The primary outcome was the prevalence of postoperative liver injury, defined as ≥ 3 × upper limit of normal of the serum levels of alanine aminotransferase (ALT) or aspartate aminotransferase.
RESULTS
The rate of postoperative liver injury was 76.9% among 1711 eligible patients. After PSM, patients who received perioperative MgIG had a significantly greater reduction in the prevalence of liver injuries than those who only received postoperative MgIG on postoperative day (POD) 3 (53.3% vs 69.1%; P = 0.006) and POD 7 (14.2% vs 23.6%; P = 0.027). The proportions of patients with ≥ 50% reduction in ALT were significantly higher in patients treated with MgIG plus other liver protectants than those treated with other liver protectants on POD 3 and 7, and upon hospital discharge. Multivariable analysis indicated an independent protective role of prophylactic MgIG in postoperative liver injury.
CONCLUSION
This study indicates that the addition of preoperative prophylaxis to postoperative treatment with MgIG can mitigate of the rise of aminotransferases and enhance postoperative liver function recovery, conferring benefits on more surgical patients.
Core Tip: In this real-world study of 1711 patients undergoing hepatectomy, magnesium isoglycyrrhizinate demonstrated meaningful benefits in preventing and treating postoperative hepatic injuries. Perioperative magnesium isoglycyrrhizinate significantly reduced the incidence of liver injury and accelerated postoperative liver function recovery vs postoperative use alone. The patients in the prophylaxis group had significantly lower alanine aminotransferase levels on postoperative day 1 compared to the non-prophylaxis group. Even without prophylaxis, postoperative magnesium isoglycyrrhizinate was also associated with higher rates of alanine aminotransferase improvement. Multivariable analysis confirmed its independent protective effect. These findings suggest that adding preoperative magnesium isoglycyrrhizinate prophylaxis enhances postoperative hepatic recovery and benefits a broader surgical population.
