27 www.dnymladychinternistu.cz | 40. DNY MLADÝCH INTERNISTŮ OLOMOUC | 1.–2. června 2023 tácii) s porovnaním v rámci skupiny s a bez ATB profylaxie. Výsledky: Pacienti v skupine bez ATB profy‑ laxie mali signifikantne vyššiu hladinu takrolimu v čase extrakcie pig tail (p = 0,0274) a signifikant‑ ne vyššiu dávku kyseliny mykofenolovej v čase protokolárnej biopsie (p = 0,0429). Signifikantný rozdiel vo výskyte pozitívneho močového nálezu v čase extrakcie pig tail, ani v čase protokolárnej biopsie sme nepotvrdili. Doplnili sme univariant‑ nú analýzu (logistická regresia) s cieľom identifi‑ kovať potenciálny rizikový prediktor pre pozitívny močový nález v čase extrakcie pig tail a realizácie protokolárnej biopsie. Žiadny zo sledovaných parametrov, vrátane ATB profylaxie sa nepotvrdil ako rizikový, respektívne protektívny faktor. Záver: Použitie antibiotickej profylaxie pri miniinvazívnych výkonoch (extrakcia pig tail, protokolárna biopsia) v potransplantačnom ob‑ dobí nemalo v našom súbore vplyv na pozitívny kultivačný nález. Na základe našej analýzy, preto v prípade týchto výkonov na našom pracovisku protokolárne nepoužívame antibiotickú pro‑ fylaxiu. Metabolomics approach in the diagnosis of acute kidney rejection Vnučák M., Graňák K., Beliančinová M., Kleinová P., Baranovičová E., Dedinská I. Transplatačné centrum Univerzitná nemocnica Martin, I. interná klinika JLF UK a UNM Background and Aims: Non‑invasive dia‑ gnosis of graft rejection after kidney transplanta‑ tion is still an unresolved issue. Changes in serum metabolite concentrations reflect the various processes involved in the graft - and thus graft rejection. Metabolomics approach might help with non‑invasive diagnosis of graft rejection ba‑ sed on identification of T‑cell activation. Method: In a group of 55 patients after primary kidney transplantation (average follow up 68.4 months, median 59 months) we identified patients with cellular rejection (ACR), antibody mediated re‑ jection (AMR) and control group (CG) - patients without history of graft rejection. We used NMR metabolomic approach to determine the relative levels of metabolites in blood plasma. Results: From 23 evaluated metabolites: lacta‑ te was significantly increased in CG and in ACR against AMR (p<0.05), whilst plasma glutamine decreased in CG against ACR (p<0.05) and AMR (p<0.05) groups. Further, tyrosine was significantly increased in CG against AMR (p AMR. When discri‑ minating CG and AMR, Random Forest discrimina‑ tory algorithm performed with AUC= 0.849 when included also evaluated plasma creatinine and with AUC = 0.83 when creatinine was excluded (other metabolites with the highest discriminatory power were glutamine, lactate, tyrosine and BCKAs). Conclusion: Metabolomic approach to blo‑ od plasma in patients after kidney transplantati‑ on seems to be very promising when looking for non‑invasive techniques assessing graft viability/ survival. The observed metabolomic changes were able to very well discriminate between patients with AMR and control group. However, discrimination of ACR against CG and AMR was rather poor.
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