Point-of-Care Ultrasound in Post-Kidney Transplant Patients: Venous Excess Ultrasound Score and Lung Ultrasound for Fluid Assessment

INTRODUCTION: Accurate volume assessment during the immediate post-kidney transplantation period reduces morbidity and mortality. Lung ultrasound (LUS), venous excess ultrasound score (VExUS), and bioimpedance analysis (BIA) are emerging methods for volume evaluation. We hypothesise LUS+VExUS may provide accurate means of congestion assessment in renal transplant patients, allowing more precise care. METHOD: An exploratory, prospective, single-centre pilot study was conducted. A prospective cohort (Group 1, n = 31) underwent volume assessment using a combined VExUS + LUS protocol on days +1 and +7 post-transplantation, alongside physical examination (PhE) and BIA. Findings were compared with a historical reference cohort (Group 2, n = 40) managed with standard clinical assessment alone. RESULTS: Groups differed significantly in delayed graft function (45.2% vs. 15.0%, p = 0.008) and cold ischaemia time (p = 0.027). Acute pulmonary oedema occurred in 2/31 patients (6.5%) in Group 1 and 6/40 (15.0%) in Group 2, though this difference was not statistically significant (Fisher exact p = 0.452). VExUS showed no correlation with BIA (Spearman ρ = 0.127, p = 0.545), BNP (ρ = 0.187, p = 0.349), or Ca125 (ρ = 0.241, p = 0.226). VExUS detected venous congestion (grade ≥1) in 2/14 patients (14.3%) with normal PhE on Day +1. PhE showed poor agreement with VExUS (κ = 0.043) and moderate agreement with LUS (κ = 0.469). Combined ultrasound identified subclinical congestion in 28.6% of patients with normal PhE. Ultrasound findings prompted therapeutic modifications in 74.2% of cases on Day +1 (primarily IV fluid reduction) and 16.1% on Day +7. CONCLUSION: In this exploratory pilot study, VExUS and LUS provided additional diagnostic information beyond PhE and influenced clinical decision-making in the majority of cases. These hypothesis-generating findings warrant confirmation in larger, multicentre, prospective studies with standardised protocols.