The study will be conducted at Max Superspeciality Hospital Saket over a period of nine months and will include adult patients with chronic liver disease undergoing living related liver transplantation. Patients with preoperative acute kidney injury, chronic kidney disease, or those who refuse consent will be excluded. A total of one hundred and five participants will be enrolled, accounting for expected attrition, based on prior data regarding the diagnostic performance of VExUS for predicting acute kidney injury. 

All enrolled patients see standard preoperative evaluation and intraoperative anesthetic management as per institutional protocol. Postoperatively, patients will be monitored in the liver transplant intensive care unit. Venous Excess Ultrasound assessment will be performed at the bedside on postoperative days one two and three. The assessment includes measurement of inferior vena cava diameter and Doppler evaluation of hepatic vein portal vein and intrarenal venous flow to generate a VExUS grade ranging from zero to three indicating increasing severity of venous congestion. Renal resistive index will also be measured on the same days using Doppler ultrasound. 

Renal function will be assessed daily until postoperative day three using serum creatinine urea estimated glomerular filtration rate and urine output. Acute kidney injury will be diagnosed and staged according to KDIGO criteria. The primary objective is to determine the association between VExUS grade and the occurrence and severity of postoperative acute kidney injury. The secondary objective is to assess the association between renal resistive index and acute kidney injury in this population. 

Data will be analyzed using standard statistical methods to describe patient characteristics and to test associations between VExUS grades renal resistive index and acute kidney injury. Diagnostic performance measures and receiver operating characteristic analyses will be used where appropriate. The study involves no additional risk or cost to participants as all investigations are part of routine clinical care and all data will be handled confidentially in accordance with ethical guidelines.