Comparative Impact of Standardized Conventional Care, Pulse Pressure Variation-Guided, and Stroke Volume Variation- Guided Fluid Therapy on Total Intraoperative Fluid Administration and Postoperative Outcomes in Liver Transplantation: A Randomized Controlled Trial

Liver transplantation is a complex surgical procedure, characterised by major fluid shifts, significant hemodynamic instability, coagulopathy. Optimal intravascular volume management during surgery is essential for maintaining organ perfusion, minimising bleeding, supporting graft function, and preventing postoperative complications. PPV and SVV are dynamic preload indices proven to predict fluid responsiveness better than static markers. Goal directed fluid therapy using PPV/SVV improves outcomes in major surgeries However, their reliability may be altered by liver transplant physiology (low SVR, open abdomen, reperfusion events). Limited data exist on PPV-/SVV-guided therapy specifically in liver transplantationThis is a randomized control study to compare the effectiveness of Standardized Conventional Care vs Pulse Pressure Variation–Guided vs Stroke Volume Variatio****n - Guided fluid therapy on total intraoperative fluid administration and postoperative outcomes in adult patients undergoing orthotopic liver transplantation. Secondary objectives are to compare the different strategies with regard to Incidence and severity of post-reperfusion syndrome, Vasopressor requirement (total dose, µg per kg per min), Postoperative pulmonary function (e.g., Duration of postop mechanical ventilation, PaO2:FiO2 ratio, need for re-intubation, pulmonary complications such as fluid overload, ARDS or pneumonia), Postoperative USG Lungs, Post-op liver function (AST, ALT, INR, bilirubin), Incidence of acute kidney injury (KDIGO criteria), Length of ICU and hospital stay (days), 30-day graft-related complication and30-day patient mortality.