*Purpose: Recently our group demonstrated the role of myosteatosis in inferior perioperative outcomes (Czigany et al. Am J Transplant 2019) in recipients of orthotopic liver transplantation (OLT). Here we aimed to investigate the effects of BC on long-term graft- and patient survival following OLT.

*Methods: The data of 225 consecutive OLT recipients were analyzed (05/2010-01/2018). Computed tomography-based lumbar skeletal muscle index-SMI, and mean skeletal muscle radiation attenuation-SM-RA were calculated using a segmentation tool (3DSlicer). Patients with sarcopenia (low SMI), and myosteatosis (low SM-RA) were identified using predefined cutoff values.

*Results: The cutoff values of myosteatosis resulted in a good stratification of patients into low- and high-risk groups in terms of survival. The overall graft- and patient survival rates were significantly lower in myosteatotic patients compared to the subgroup of patients with higher SM-RA values (p=0.011, p=0.001, respectively). Sarcopenia alone was not associated with significant differences in graft- and patient survival rates (p=0.273, p=0.278, respectively). Dividing the patient cohort into quartiles, based on the values of SMI and SM-RA, resulted in significant differences between the SM-RA quartiles in terms of patient survival but not of graft survival (p=0.011). Accordingly, myosteatosis was identified as an independent predictor of inferior patient survival in our cohort (Hazard ratio: 2.260, Confidence interval: 1.177-4.340, p=0.014).

*Conclusions: Our study identifies preoperative myosteatosis as an important factor of inferior graft- and patient survival in liver transplant recipients. These findings underline the clinical significance of preoperative body composition assessment in potential OLT recipients.

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