*Purpose: Chronic liver disease is often associated with testosterone deficiency. However, testosterone therapy does not improve survival. So far, after a successful liver transplant (LTx), testosterone replacement therapy for functional sarcopenia is not studied. Purpose: 1) Define post-LTx functional sarcopenia with serum testosterone level. 2) Examine the role of short-term testosterone replacement therapy with the active in-bed exercise of upper and lower extremity joints. 3) Correlate functional sarcopenia with skeletal muscle index (SMI) and skeletal muscle density (SMD) in relation to ascites, pleural effusion subtracted (APES) body mass index (BMI).

*Methods: Sixteen post-LTx recipients received testosterone replacement therapy with functional sarcopenia, defined as 1) inability to get out of bed and stand with help of two physiotherapists, within 24 hours post-extubation, and/or ventilatory dependency >2 days post-LTx with allograft and without major complications. Pre- and post-operative demographics, laboratory, and radiological data were retrieved; BMI, SMI, and SMD were calculated. (Figure 2)

*Results: The mean testosterone level was 28.3 ng/dL. 12 patients received one dose and the remaining four received >1 dose of testosterone cypionate 200mg. Mean hospital stay was 26 days. Seven patients were discharged home and the remaining nine to a rehabilitation facility or nursing home. One patient died from a cardiac event and another from recurrent metastatic malignancy. One- and five-year actuarial patent and graft survival were 93.8% and 87.5%, respectively ( Figure-1A). Overall, five subjects were sarcopenic by SMI, and six subjects had poor muscle quality by SMD. (Figure-1B)

*Conclusions: Post-LTx testosterone deficiency exists with functional sarcopenia. Two-thirds of recipients either have low SMI and/or have low SMD. Short-term testosterone replacement therapy with in-bed active exercise provides five-year patient and graft survival of 87.5%. The dosing, frequency, risk, and benefit of testosterone replacement therapy for LTx recipients with various degrees of functional sarcopenia could be evaluated. studies.

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