Tissue hypoperfusion caused by prolonged hypotension and reduced cardiac output results in tissue hypoxia, enhanced anaerobic metabolism, and lactic acid accumulation. Stasis in the visceral and inferior vena cava system also leads to hypoxia in that part of the tissue and increased lactic acid production. There is also a large accumulation of lactic acid in the gastrointestinal tract during hypoxia, and the lactic acidemia is exacerbated by the return of the inferior vena cava to the body circulation with blood flow after opening. In addition, the donor liver may also have lactate production and accumulation during hypothermia and hypoxia during preservation. The liver and kidneys are the main sites of lactate removal, and the myocardium is the other major organ for lactate elimination. The lack of lactate metabolism during the anaphylactic period, along with the decreased ability of the kidneys to metabolize lactate due to inadequate blood perfusion, inevitably results in lactate accumulation. It is worth noting that lactic acidosis can sometimes be accompanied by ketoacidosis and hypertonic non-ketotic hyperglycemic coma, thus adding to the diagnostic complexity. The diagnosis of lactic acidosis can be made without blood lactate measurement in those who are in shock with acidosis, but in those who are in acidosis without tissue malperfusion, blood lactate level must be measured to confirm the diagnosis. The main points of diabetic lactic acidosis are: 1. Diabetes mellitus, but most patients are not very hyperglycemic and do not have significant ketoacidosis. 2. A significantly elevated blood lactate level, mostly above 5mmol/L is the main basis for the diagnosis of lactic acidosis. Blood lactate level exceeds normal (>1.8 mmol/L), and in 2-5 mmol/L, mostly compensatory acidosis This kind of only excessive lactate without acidosis can be diagnosed as hyperlactatemia. 3. Evidence of acidosis such as pH <7.35, blood bicarbonate <20mmol/L, anion gap >18mmol/L, etc. Diabetic lactic acidosis can be confirmed if the diagnosis of ketoacidosis such as renal failure can be ruled out, combined with significantly elevated blood lactate level.