Short-term treatment with mycophenolic acid increases bile flow in continuously perfused and cold-preserved rat livers and does not affect hepatic ischemia-reperfusion injury

Mycophenolate mofetil (MMF) is a new immunosuppressive agent which has been used successfully after kidney and heart transplantation. Experience with MMF after liver transplantation is still limited. In particular, there is no information about influence on ischemia-reperfusion injury (IRI). Therefore, the aim of this investigation was to assess the effects of mycophenolic acid (MPA), the pharmacologically active metabolite of MMF, in the cold-preserved or normal rat liver. Livers of male Sprague-Dawley rats were subjected to cold ischemia in University of Wisconsin (UW) solution (24 h, 4 degrees C) and reperfused for 2 h in the absence or presence of MPA (100 microg/ml, n=5-6 each). Another group received MPA pretreatment for 20 min prior to ischemia ( n=7). In further experiments, livers were perfused with a bile salt-free Krebs-Henseleit buffer in a continuous fashion (controls, n=5). MPA was infused from 20-40 min after starting perfusion in therapeutic concentrations (5 microg/ml, 10 microg/ml, 40 microg/ml, and 100 microg/ml; n=3-6 each). There was no significant influence of MPA on portal pressure nor on postischemic efflux rates of LDH. MPA pretreatment resulted in a significant improvement of bile flow during reperfusion (0.32+/-0.05 microl/min x g liver) compared with controls (0.17+/-0.04 microl/min x g liver, mean+/-SEM). In contrast, postischemic bile flow was not influenced by continuous administration of MPA during the reperfusion period only (0.18+/-0.07 microl/min x g liver). In continuously perfused livers, MPA increased bile salt-independent bile flow (1.00+/-0.06 microl/min x g liver) in a dose-dependent manner, reaching half-maximal effects around 5 microg/ml (1.66+/-0.15 microl/min x g liver) and maximal effects at 40 microg/ml (2.61+/-0.28 microl/min x g liver). In conclusion, neither preischemic nor postischemic administration of MPA influences IRI to hepatocytes significantly after hypothermic liver preservation in UW solution. In contrast to other immunosuppressive agents, MPA exhibits strong choleretic effects, which are related to a stimulation of bile salt-independent bile formation.