*Purpose: Lactic acid (LA) serves as an important biomarker in the evaluation of ischemia, sepsis, metabolic acidosis, and trauma. During renal transplantation (RT), there is cross-clamping of the iliac vessels and implantation of an ischemic organ. There is a paucity of literature on the effect that RT has on serum LA. This is important considering that many hospitals use LA as part of the automated sepsis workup.

*Methods: A retrospective review of patients undergoing RT at the University of Missouri from August 2017 through November 2018 was performed. Serum LA was obtained at admission and in the first post-op lab draw. Comparisons were made between pre/post-op serum LA of all patients. Statistics used included t-test and unequal variance t-test with an alpha value of 0.05.

*Results: 22 patients met inclusion criteria during our study period and none were diagnosed with sepsis. Overall, there was a significant increase in serum LA postoperatively (p= 0.001). Significant increases in pre-op vs post-op serum LA levels were seen in patients receiving cadaveric RT, prolonged anastomosis (greater than 60 minutes), normal anastomosis, male, and female groups (p= 0.001, 0.037, 0.011, 0.019, 0.012 respectively). Unlike in patients receiving cadaveric RT, patients receiving living donor RT did not see a significant increase in LA (n=5, p=0.222). When comparing the post-op LA in cadaveric vs living, prolonged anastomosis vs normal anastomosis, and male vs female, there were no significant differences noted (p = 0.077, 0.936, 0.562, respectively).

*Conclusions: Our results suggest that there is an increase in serum LA following RT in most settings except for living donor RT. Further evaluation is needed to assess the significance of LA levels in transplant patients when evaluating for sepsis as none of our patients were diagnosed with sepsis.

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