The effect of cyclosporin A on the hepatic energy status and intracellular pH of the liver and its response to a fructose challenge has been investigated using in vivo phosphorus-31 nuclear magnetic resonance spectroscopy in dogs. Three experimental groups were studied: (a) control dogs (n = 5), (b) dogs 4 days after the creation of an end-to-side portacaval shunt (n = 5), and (c) dogs 4 days after portacaval shunt and continuous infusion of cyclosporin A (4 mg/kg/day) by way of the left portal vein (portacaval shunt plus cyclosporin A, n = 5). The phosphorus-31 nuclear magnetic resonance spectra were obtained at 81 MHz using a Bruker BIOSPEC II 4.7-tesla nuclear magnetic resonance system equipped with a 40-cm horizontal bore superconducting solenoid. The phosphomonoesters (p < 0.01), inorganic phosphate and ATP levels (p < 0.05) were decreased significantly in portacaval shunt–treated and in portacaval shunt-pluscyclosporin A–treated dogs compared with unshunted control dogs. After a fructose challenge (750 mg/kg body wt, intravenously), fructose-1-phosphate metabolism was reduced in portacaval shunt–treated dogs compared with either the normal or portacaval shuntplus-cyclosporin A–treated dogs (p < 0.05). Both portacaval shunt– and portacaval shunt-plus-cyclosporin A–treated dogs demonstrated a reduced decline in ATP levels after fructose infusion when compared with the controls (p < 0.05). Immediately after the fructose challenge, the intracellular pH decreased from 7.30 ± 0.03 to 7.00 ± 0.05 in all animals (p < 0.01) and then gradually returned to normal over 60 min. These data, obtained in vivo using phosphorus-31 nuclear magnetic resonance spectroscopy of the liver after a portacaval shunt, suggest that: (a) the energy status of the liver is reduced in dogs with a portacaval shunt compared with that of normal controls and (b) cyclosporin A treatment ameliorates the reduction in hepatic metabolism normally observed after a fructose challenge to the liver with a portacaval shunt. (HEPATOLOGY 1991;13:780–785.)