Objective Liver transplantation is an effective treatment for end-stage liver disease. However，early postoperative acute hypoxemic respiratory failure （AHRF） is one of the most critical medical complications，impeding rapid recovery. The etiology of post-liver transplantation AHRF is diverse， and the correlation betweenperioperative fluid management strategies and AHRF remains unreported in the literature. Whether specific fluid management strategies benefit AHRF patients is still unclear. This study aims to evaluate the impact of postoperative fluid management on AHRF and to analyze whether pulse index continuous cardiac output （PiCCO）-guided fluid therapy confers benefits， thereby optimizing clinical protocols. Methods Clinical data from 81 liver transplant recipients admitted to the Department of Critical Care Medicine， Renji Hospital， Shanghai Jiao Tong University School of Medicine， between December 2024 and April 2025 were retrospectively analyzed. Preoperative indicators （age，transplant type， electrocardiogram， cardiac ultrasound）， intraoperative blood loss， fluid infusion volume， peak lactatelevels， and postoperative PiCCO-based hemodynamic parameters were collected. The time to AHRF onset， etiology（infectious/non-infectious）， ICU stay， hospitalization duration， and their impacts on graft function and survival rates were evaluated. Results The incidence of postoperative AHRF was 22.2% （18/81）， with a median onset time of 3 days posttransplant. Among AHRF patients，72.2% （13/18） had non-infectious causes， and 27.8% （5/18） had infectious causes.AHRF occurrence showed no correlation with preoperative electrocardiogram or cardiac ultrasound findings， intraoperative blood loss， vasoactive drug use， peak lactate levels， postoperative portal vein velocity， hepatic artery velocity， or hepatic artery resistance index. Compared to non-AHRF patients， the AHRF group achieved comparable mean arterial pressure targets but exhibited a significantly higher fluid positive balance on postoperative day 1， elevated volume preload indicators， and increased extravascular lung water （EVLW） on days 1 and 2. The occurrence of AHRF prolonged ICU stays and total hospitalization duration. Conclusion Early postoperative AHRF in liver transplant recipients is associated with higher volume load and increased EVLW. PiCCO-guided monitoring of preload volume parameters 〔e.g.， global end-diastolic volume（GEDV）〕 facilitates optimal fluid management. Targeting GEDV at the lower limit of the normal range may represent a rational fluid management strategy. 

Objective To analyze the correlation between cardiac output（CO） parameters and hepaticblood flow， liver function， and inflammatory response after pediatric liver transplantation. Methods Thisstudy included 39 pediatric liver transplant patients from Tianjin First Central Hospital. Cardiac output and circulatorydynamics parameters were collected on the first postoperative day using a non-invasive ultrasound cardiac output monitor. Liver function， hepatic blood flow， NT-proBNP， and inflammatory markers were recorded on the first， third， and fifthpostoperative days. Spearman correlation analysis was used to explore the relationship between cardiac output parameters and liver function， hepatic hemodynamics， cardiac function， and inflammation. Results CO was positively correlatedwith HA PSV and mean arterial pressure （MAP） on postoperative day 1（P ＜ 0.05） and negatively correlated with PVflow， aspartate transaminase （AST）， white blood cell（WBC）（P ＜ 0.05）， as well as NT-proBNP on postoperative day 5 （P ＜ 0.05）. Cardiac index（CI） was negatively correlated with TBil on postoperative days 3 to 5（P ＜ 0.05）. SVR waspositively correlated with HA PSV and AST on postoperative day 1， and with NT-proBNP on postoperative day 5（P＜0.05）. CVP was negatively correlated with PV flow （P ＜ 0.05）. Conclusion Early cardiac output following pediatric livertransplantation correlates with hepatic blood flow， liver function， NT-proBNP， and inflammatory markers， confirming its potential significance as an early risk indicator. This suggests early cardiac output may serve as a reference indicator for earlyassessment of transplanted liver function and hemodynamic risk. 

Objective To investigate the impact of perioperative fluid management on postoperative pulmonary complications （PPCs） following liver transplantation and to evaluate the role of nursing interventions in improving patient outcomes. MethodsA retrospective analysis was performed on 269 patients who underwentliver transplantation between January 2023 and December 2024 in the First Hospital of Jilin University. Patients were classified into a PPCs group （n ＝ 147） and a non-PPCs group （n ＝ 122） based on the occurrence of PPCs within 7 d postoperatively. Preoperative baseline characteristics， intraoperative fluid administration， blood loss， blood product transfusion， cumulative fluid balance within 24 ~ 72 h after surgery， duration of endotracheal intubation were compared between the two groups. In addition， nursing interventions were analyzed. ResultsIntraoperative fluid administration， blood product transfusion， and blood loss were significantly higher in the PPCs group than in the non-PPCs group （P ＜ 0.05）. Cumulative fluid balance remained positive， and urine output was lower 24 ~ 72 h postoperatively. In contrast， some patients in the non-PPCs group approached a negative fluid balance 48 ~ 72 h after surgery. Patients inthe PPCs group had significantly longer intubation duration （P ＜ 0.01）. Retrospective data indicated that the nursingteam contributed positively to fluid management safety and complication prevention through interventions such as dynamic monitoring， refined fluid regulation， medication management， and respiratory support. ConclusionExcessive perioperative fluid administration and sustained fluid retention are major risk factors for PPCs after liver transplantation. The combination of perioperative fluid therapy and standardized， refined nursing interventions has been demonstrated to facilitate the achievement of fluid balance， reduce the incidence of pulmonary complications， and enhance the quality of postoperative recovery and prognosis. 

Objective To summarize our experience in postoperative volume assessment and management for adult patients undergoing split liver transplantation. Methods A retrospective analysis was conducted onthe volume management data of 71 split liver transplantation （SLT） patients between January 2024 and July 2025 inthe First affiliated hospital，Zhejiang University School of Medicine， and the incidence of related complications wasdissected. Results Utilizing an "Assessment-Intervention-Prevention" volume management strategy，the observedrates of volume-management-related complications among the 71 patients were as follows ： delayed graft function 5.63%，pulmonary edema 1.41%， acute kidney injury 4.23%， and abdominal compartment syndrome 0. The ICU stay was 8（7，11） days， and the overall hospital length of stay was 30（24，36） days. Conclusion The "AssessmentIntervention-Prevention" volume management strategy effectively balances the conflict between volume insufficiency and fluid overload， providing crucial support for improving transplant outcomes. 

Objective To investigate the role of ultrasound-based volume assessment in perioperative fluid management of liver transplant recipients. Methods A total of 106 end-stage liver disease patients who underwent liver transplantation at the Liver Transplantation Center， China-Japan Friendship Hospital， between September 2020 and April 2024 were enrolled. Using a historical control design， patients were divided into two groups based on whether postoperative ultrasonic volume indices were monitored. Cumulative intensive care unit （ICU） fluid balance and length of ICU stay were compared between the groups. Results Baseline characteristics （sex， age， BMI， etiology） were comparable. Pre-transplant MELD-Na scores （23 ± 10 vs. 22 ± 9，P ＝ 0.654） and APACHE II scores on ICU admission 〔19（5）vs. 19（3），P ＝ 0.525〕 were not statistically different. Patients in the ultrasound-monitored group （n ＝ 53）had longer operative times 〔10.0（3.1） h vs 9.4（2.3） h，P ＝ 0.016〕 and greater intraoperative fluid balance 〔（5341± 3447） ml vs.（1728 ± 2519） ml，P ＜ 0.001） than the non-monitored group. However， cumulative ICU fluid balance 〔-863（4600）ml vs. -48（2786）ml ，P ＝ 0.029〕 and daily fluid balance〔-276（1123）ml vs. -12（811）ml， P ＝ 0.017〕 were lower in the ultrasound-monitored group. Mechanical ventilation duration， ICU length of stay， and totalhospital stay did not differ between groups. Subgroup analyses showed no clear association in ultrasonic volume indices （lung ultrasound score， E-wave velocity， and renal venous congestion grading） for three consecutive days after the patients were transferred to the general ward and the incidence of AKI within 48 h post-operation was comparable（P ＞0.05）. Conclusion Ultrasound-assisted perioperative volume assessment in liver transplant recipients can mitigate fluid overload but does not shorten hospital stay. 

Objective To analyze the fluid management plan and early clinical outcomes of patients after heart transplantation. Methods The clinical data of 121 heart transplant recipients were retrospectively analyzed in Chinese Academy of Medical Sciences Fuwai Hospital. The data on early fluid usage of the patients were sorted out and analyzed. Meanwhile， the occurrence and clinical outcomes of the main early complications of heart transplant patients after surgery were summarized and described. Results The negative fluid balance on the day after surgery was （1729.5±861.8） ml. The negative fluid balance from the 1st to the 3rd day after surgery was （1138.6±805.2） ml，（696.7±779.2） ml， and （527.1±694.3） ml respectively. The amount of colloid used on the day after surgery was 826.4±503.0 ml， and the average venous pressure was （3.0±2.0） mmHg. A total of 4 patients died in the hospital. Postoperative blood transfusion accounted for 14.9%， postoperative application of CRRT accounted for 5.0%， and secondary thoracotomy exploration accounted for 5.8%. Conclusion For heart transplant patients after surgery， the early management was guided by central venous pressure， in addition to floating catheter parameters， and through multiparameter guided dynamic fluid management. The risk of in-hospital death and the incidence of major complications of hearttransplant patients after surgery were at a relatively low level. 

Objective To evaluate the effect of perioperative nursing intervention for renal transplant recipients based on dynamic volume management assessment. Methods A retrospective analysis was conducted on 112 adult renal transplant recipients who underwent deceased donor renal transplantation in Shanxi Provincial Second People's Hospital from January 2024 to June 2025， with complete preoperative and postoperative data. All recipientsreceived a full-course dynamic assessment-based volume management nursing intervention model， which included the following components: re-evaluation of the basic volume status to adjust the appropriate dry weight， conduction of24 h preoperative weight monitoring to provide baseline data， and performance of dynamic assessment postoperatively by combining vital signs， auxiliary examinations， and impedance cardiography. Results Dynamic assessment-basedvolume management reduced perioperative complications after renal transplantation. Within 7 days postoperatively，the incidence rates of acute coronary syndrome， acute pulmonary edema， congestive heart failure， delayed graft function andintestinal obstruction were 3.6% （4/112 cases），0.9% （1/112 cases），3.6% （4/112 cases），17.9% （20/112 cases） and 3.6% （4/112 cases）. Except for one new case of congestive heart failure that occurred after 7 days， all other complicationsoccurred within 7 days. Conclusion Dynamic volume assessment （dominated by impedance cardiography） is beneficial for fluid management in kidney transplantation and reduces perioperative complications. 

Objective To explore the impact of fluid therapy on early renal function in polyuria stage afterkidney transplantation （KT）. Methods The retrospective study of clinical data from 115 living donor kidney transplant recipients at Tianjin First Central Hospital was conducted. Patients were grouped according to eGFR at 6-month after KT ：a good renal function group （eGFR≥ 60） and a poor renal function group （eGFR＜ 60）. The general data， intake and output volume， blood pressure， and other indicators were compared， and multifactorial logistic regression was used to predict the risk factors for poor recovery of transplanted kidney function. The correlation between the change of renal function and daily urine volume was analyzed. Results After adjusting for age， BMI and the use of vasoactive drugs during surgery， patients with higher fluid balance on total fluid balance within postoperative 3 d （OR＝1.321，95% CI＝1.005～1.736，P＝0.046） had a higher risk of poor renal function at 6-month. In addition， the decrease rates of serum creatinine （Scr）（r ＝ 0.518，r ＝ 0.267） and blood urea nitrogen （BUN）（r ＝ 0.555，r ＝ 0.322） at postoperative day 1 and day 2 were positivelycorrelated with the urine volume of the previous day （all P ＜ 0.05）. Conclusion In stage of polyuria after KT，appropriate negative fluid balance is beneficial to the recovery of early renal function in recipients with stable blood pressure. 

Objective To explore the distribution characteristics of pathogens， antimicrobial resistanceand prognostic factors of perinephric infection after kidney transplantation. Methods clinical data of patients with perinephric infection after kidney transplantation from January 2018 to January 2025 were collected retrospectively，distribution characteristics of pathogens，antimicrobial susceptibility testing results of patients were statistically analyzed.Patients were divided into improved prognosis group and the poor prognosis group according to 14 d prognosis. Thedifferences in clinical data between two groups of patients were compared，and influencing factors for the prognosis of patients with perinephricinfection after kidney transplantation were evaluated. Results A total of 148 patientswith perinephric infections were included in the study，208 strains of pathogenic bacteria were isolated，including gramnegative bacilli （108 strains，51.92%），gram positive bacteria（66 strains，31.73%），mycoplasma hominis（20 strains，9.62%）and fungi（14 strains，6.73%）. The main gram negative bacteria were Pseudomonas aeruginosa and Klebsiella pneumoniae with resistance rates to penicillin. The other bacteria with more than 50% positivity were cephalosporins，carbapenems， aminoglycosides， and quinolones. Fifty-two strains （25%） of multidrug-resistant Gram negative bacteria was detected..The resistance rate of Enterococcus faecium to penicillin and levofloxacin is 100%， and the resistance rates to ampicillin and erythromycin are 91.84% and 87.76%， respectively. The resistance rate of Enterococcus faecalis to penicillin and erythromycin is 64.71%. Multivariate analysis showed that CRPA（OR ＝ 5.257，95%Cl ＝ 2.097~13.177）and CRKP（OR ＝ 10.711，95%Cl ＝ 2.942~38.993）were independent risk factors for the death of patientswith poor prognosis （P ＜ 0.05）. Conclusion Gram negative bacteria are the main cause of perinephric infections after kidney transplantation， and the detection rate of MDRO is high. Perirephric infections of CRPA and CRKP are independent risk factors for the renal transplant recipients. It is necessary for the clinicians to use antimicrobial agents rationally， and strengthen hospital infection monitoring and screen for multidrug-resistant bacteria from donor kidneys before transplantation.