Impact of perioperative hydrocortisone administration on the regeneration of the future liver remnant in right lobe living-related liver donors

Abstract

Liver transplantation from a living-related donor remains one of the most effective treatments for end-stage liver disease. Ensuring maximum donor safety and preventing postoperative liver failure is an absolute priority. A key factor in the favorable postoperative course in donors after right hemihepatectomy is the rapid and complete regeneration of the future liver remnant (FLR). Liver resection and unavoidable ischemia-reperfusion injury trigger a cascade of systemic inflammatory responses with a massive release of pro-inflammatory cytokines, particularly interleukin-6. While controlled inflammation is necessary to initiate the regeneration process, hyperinflammation can disrupt microcirculation and slow early parenchymal recovery. Perioperative glucocorticosteroid administration is an effective method of modulating inflammation, yet its direct impact on morphological regeneration in living donors remains insufficiently studied.

Objective – to investigate the effect of perioperative intravenous hydrocortisone on the dynamics of the regenerative capacity of the future liver remnant in living-related donors after right hemihepatectomy using computed tomography (CT) volumetry.

Materials and methods. A prospective randomized controlled trial was conducted at the Oberig Clinic from September 2023 to December 2025. The study included 100 right lobe living-related liver donors. The experimental group (Group A, n=50) received an intravenous bolus of 500 mg hydrocortisone sodium succinate 10 – 15 minutes before parenchymal transection, followed by 100 mg/day on postoperative days 1 to 5. The control group (Group B, n=50) received standard care without systemic steroids. The left liver lobe volume was assessed using multidetector CT before surgery (RLV0), on day 14 (RLV14), and on day 90 (RLV90).

Results. Preoperative RLV0 was similar between groups (440.0±96.5 mL in Group A, 448.7±94.0 mL in Group B, p=0.649). On postoperative day 14, Group A demonstrated a significantly more intensive volume increase: RLV14 reached 889.9±181.8 mL compared to 808.3±154.3 mL (p=0.017), with a regeneration index of 106.3±37.5% vs. 84.9±42.3% (p=0.009). On day 90, the difference became highly significant: RLV90 was 1097.4±203.8 mL vs. 920.6±143.8 mL (p < 0.001), with an increase of 155.1±45.7% vs. 110.4±38.0% (p < 0.001). Hydrocortisone effectively smoothes the pathological peak of inflammation and prevents massive ischemia-reperfusion injury. Preserved from excessive apoptosis, the parenchyma receives optimal conditions for full cellular division from the first days.

Conclusions. Perioperative intravenous hydrocortisone is safe and does not suppress liver recovery. Modulation of the systemic inflammatory response significantly increases the intensity of morphological regeneration of the left liver lobe, as confirmed by a significant increase in absolute volume and regeneration index in both early (p=0.009) and late (p < 0.001) postoperative periods.