Minocycline Administration During Human Liver Transplantation

Liver transplantation is the sole therapy for end-stage liver diseases in children and adults. However, use of this life-saving technique is limited due to a severe shortage of donor livers and, consequently, over 1500 patients/year on waiting lists die prior to transplantation due to organ shortages. Also, poor immediate graft function remains a persistent problem especially in recipients of marginal livers, and biliary strictures evolving from reperfusion injury cause prolonged hospital stay, increased health care costs, and increased mortality. Furthermore, hepatic cold storage and reperfusion in transplantation settings cause mitochondrial dysfunction in liver cells, which constitutes a great risk for primary nonfunction and initial poor function after liver transplantation. The tetracycline derivative minocycline is a safe and widely used antibiotic that possesses cytoprotective effects through prevention of mitochondrial dysfunction in a variety of disease models. Recently, we showed that minocycline also protects against graft dysfunction and failure after orthotopic rat liver transplantation and against cell death after ischemia-reperfusion to cultured rat hepatocytes. Minocycline treatment specifically prevented mitochondrial dysfunction and increased graft and animal survival by blocking necrotic and apoptotic death pathways. Clinical studies indicating severe deterioration of mitochondrial function in livers during preservation provide a strong impetus to investigate minocycline as an effective agent to decrease injury and improve graft function after human clinical transplantation.