To find out the role of serial perioperative transthoracic echocardiography and lung ultra-sonographic evaluations as a non-invasive tool for judicious fluid therapy in ESRD patients undergoing kidney transplantation surgery

Fluid therapy isusually decided peri-operatively on the basis of haemodynamicvariables like CVP, mean arterial pressure, urine output and serum lactate values.  Predicting the fluid requirements on thebasis of these variables is often unreliable even in the hands of expert anaesthesiologistsand intensive care physicians. Moreover,  renal transplantation recipients are oftenanuric and are on frequent dialysis therapy. Presence of autonomic neuropathy furtheradds to the complexity for managing these patients. Imprecisemonitoring may  lead to iatrogeniccatastrophic consequences, such as pulmonary edema due to over-hydration,impairment of pulmonary blood gas exchange, or electrolyte disturbances.

Point-of-carelung ultrasonography has a great potential for guiding the fluidmanagement of critically ill patients.6,7 B-lines have beenacknowledged as sonographic signs of pulmonary interstitial and alveolar edemain critical and emergency care settings. Literature indicates that B-lines maybe used to predict extravascular lung water (EVLW) and pulmonary arteryocclusion pressure (PAOP).8, While EVLW is a direct sign ofpulmonary congestion, PAOP estimates the pressure in an area that extends fromthe lung capillaries to the left ventricle and indicates hemodynamic congestion.10A recent study has shown a tight correlation between absence of B-lines at lungultrasound and low levels of PAOP.9 However this modality has notbeen used during renal transplant surgery where judicious fluid managementplays a vital role in the early functioning of the graft. Therfore the presentstudy has been planned to assess the utility of perioperative lung ultrasonographyin the early detection of volume overload in patients undergoing elective live-related renal transplantation .