Peat-core records have a long history of being used for paleoclimate reconstructions in northern high-latitude regions but are less common in the southern tropical zone. In this study, we present a synthesis of published peat-core reconstructions and basal ages from high-elevation (>3000 m a.s.l.) sites in the northern and central Andes of South America. We complement this database by providing a new multi-proxy peat-core-based paleoecological reconstruction from the Alta Murmurani peatland, Cordillera Vilcanota, Peru. This record, with a peat inception age of 8980 cal. yr BP, was analyzed for plant macrofossils and stable isotopes (carbon, oxygen). This review (1) assesses the timing of peat initiation and development across the tropical high-elevation region of South America (8°N to 27°S); (2) assesses the reliability of peat-core paleoclimate reconstructions by comparing the peat-core inferences across sites and against other independent archives (e.g., lake sediments, ice cores, speleothems); and (3) determines which hydroclimatic conditions are favorable for peat formation and expansion across the study area. Our results show that peat initiation occurred throughout the Holocene, progressing from the northern Andes to central Andes, with highest initiation frequencies clustered at ca. 10,700 cal. yr BP and 8300 cal. yr BP, respectively. Our synthesis reveals that peat cores can be used to assess regional paleoclimate trends in the central Andes using a multi-proxy approach combining micro- and macrofossils such as pollen, stable isotopes, as well as organic and inorganic elemental analyses. We also identify three optimal peat-forming time periods, all with optimally wet conditions occurring at transitional hydroclimate phases: (1) following deglaciation, with warming temperatures and increased moisture related to glacial runoff (ca. 11,000 cal. yr BP and ∼8000 cal. yr BP), (2) under moderate moisture regimes related to intensifying ENSO and warmer conditions (∼3500 cal. yr BP), and (3) under conditions related to increased precipitation at the beginning of a cold period (Little Ice Age). We show that either regional climate (e.g., changes in precipitation) or local conditions (e.g., changes in glacial runoff) can promote peat formation across the study region.