*Purpose: Muscle wasting and sarcopenia in kidney disease is associated with increased cardiovascular events, morbidity and mortality. Psoas muscle cross-sectional area measured on a CT image is a validated method of assessing sarcopenia in kidney disease. Here, we evaluated whether pre-transplant sarcopenia (measured by psoas muscle cross sectional area) is associated with post-transplant adverse outcomes.

*Methods: We conducted a single-center study to evaluate the association of pre-transplant sarcopenia with 3-month post-transplant re-hospitalization rates, graft loss and mortality. We measured the cross-sectional area of the psoas muscle at L4 from a pre-transplant CT scan closest to the date of transplant and compared it to post-transplant outcomes. We used a Cox proportional hazard model to analyze the association of psoas muscle cross-sectional area with graft loss, re-hospitalization and mortality.

*Results: Of the patients transplanted at our center between 2008-2017, 574 had pre-transplant CT images which we could use to calculate the psoas cross sectional area. Table 1 describes the demographic characteristics of the included patients. Psoas muscle cross sectional area was not associated with graft survival or rehospitalization rate. A lower psoas muscle cross sectional area was associated with a higher hazard for death (β coeff=-1.05e-03, p= 0.01), i.e. every increase of 100 mm² in the psoas muscle cross sectional area decreases the hazard of death by 90%.

*Conclusions: Pre-transplant sarcopenia is associated with increased mortality post-transplant.

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