*Purpose: Sarcopenia is defined as the loss of muscle mass, typically associated with aging, but frequently appearing in liver disease patients. In particular, sarcopenia present in patients with liver disease has been linked to poor outcomes post-liver transplantation. However, any link between pre-transplant sarcopenia status and aberrant metabolic homeostasis on liver transplant outcomes is unknown. The aim of this pilot study was to identify serum metabolite differences amongst patients with varying degrees of pre-transplant sarcopenia. Related pathways can then be targeted to abrogate morbidity and mortality post-transplant.

*Methods: Patients listed for transplant were characterized in terms of sarcopenia based on the ratio of psoas muscle area at the L3 vertebra related to height. Muscle mass data was collected using CT scans and SliceOMatic software. Serum samples were taken at the time of transplant. Metabolomic profiling was performed using LC/MS at the University of Washington Metabolomics Core.

*Results: In this preliminary study metabolomic profiles were performed for 18 serum samples. 152 metabolites were well-quantified in all samples. The collected data was then investigated for links with sarcopenia. Univariate identification of candidate metabolites was performed using a 2-tailed t-test between dichotomized high- and low-wasting groups. 66 metabolites were found to be different between the groups at the p <0.1 significance level, 31 of which were expressed at reduced levels in more sarcopenic patients. 24 of these were significant at the p<0.05 level, of which only 2 were depressed in more sarcopenic patients.

*Conclusions: The best trackers of sarcopenia were arabitol, inositol, and creatine. There is a high degree of co-linearity among the identified metabolites. As a result, further research is required to identify the most likely contributors to muscle wasting and targets for intervention, however, our analysis offers an excellent point from which to start.

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