| Summary: | <span style="font-variant: small-caps;">l</span>-carnitine is an important co-factor in fatty-acid metabolism, and its deficiency is associated with insulin resistance, which is independently associated with arterial stiffness. This study evaluated the relationship between serum <span style="font-variant: small-caps;">l</span>-carnitine level and peripheral arterial stiffness (PAS) in kidney transplantation (KT). Fasting blood samples were collected from 65 patients who underwent KT. We measured the brachial−ankle pulse wave velocity, and 36 patients (55.4%) had PAS. Patients with PAS had a significantly higher percentage of diabetes (<i>p</i> = 0.001), hypertension (<i>p</i> = 0.033), and metabolic syndrome (<i>p</i> = 0.044); higher waist circumference (<i>p</i> = 0.010), systolic blood pressure (<i>p</i> = 0.002), serum triglyceride level (<i>p</i> = 0.040), insulin level (<i>p</i> = 0.002), and homeostasis model assessment of insulin resistance (<i>p</i> = 0.002); lower high-density lipoprotein cholesterol (<i>p</i> = 0.036) and serum <span style="font-variant: small-caps;">l</span>-carnitine levels (<i>p</i> < 0.001); older age (<i>p</i> = 0.041); and a longer KT duration (<i>p</i> = 0.025) than those without PAS. Statistical analysis revealed an independent association between PAS in KT and KT duration (95% confidence interval (CI): 1.003−1.054, <i>p</i> = 0.029) and serum <span style="font-variant: small-caps;">l</span>-carnitine levels (95% CI: 0.842−0.998, <i>p</i> = 0.044). The area under the receiver operating characteristic curve indicated that the diagnostic power of <span style="font-variant: small-caps;">l</span>-carnitine to predict PAS was 0.789 (95% CI: 0.670−0.881, <i>p</i> < 0.001). Serum-free <span style="font-variant: small-caps;">l</span>-carnitine level is negatively associated with PAS in patients who undergo KT.
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