Fluid therapy is usually decided peri-operatively on the basis of haemodynamic variables like CVP, mean arterial pressure, urine output and serum lactate values.  Predicting the fluid requirements on the basis of these variables is often unreliable even in the hands of expert anaesthesiologists and intensive care physicians. Moreover,  renal transplantation recipients are often anuric and are on frequent dialysis therapy. Presence of autonomic neuropathy further adds to the complexity for managing these patients. Imprecise monitoring may  lead to iatrogenic catastrophic consequences, such as pulmonary edema due to over-hydration, impairment of pulmonary blood gas exchange, or electrolyte disturbances.

Point-of-care lung ultrasonography has a great potential for guiding the fluid management of critically ill patients.^6,7 B-lines have been acknowledged as sonographic signs of pulmonary interstitial and alveolar edema in critical and emergency care settings. Literature indicates that B-lines may be used to predict extravascular lung water (EVLW) and pulmonary artery occlusion pressure (PAOP).^8, While EVLW is a direct sign of pulmonary congestion, PAOP estimates the pressure in an area that extends from the lung capillaries to the left ventricle and indicates hemodynamic congestion.¹⁰ A recent study has shown a tight correlation between absence of B-lines at lung ultrasound and low levels of PAOP.⁹ However this modality has not been used during renal transplant surgery where judicious fluid management plays a vital role in the early functioning of the graft. Therfore the present study has been planned to assess the utility of perioperative lung ultrasonography in the early detection of volume overload in patients undergoing elective live- related renal transplantation .