Loss of muscle mass (sarcopenia) and muscle function (frailty) is common in elderly patients. This is called primary sarcopenia. In contrast, patients may develop sarcopenia and frailty secondary to chronic diseases like decompensated cirrhosis. With worsening of underlying liver disease, the prevalence and severity of sarcopenia increase. Presence of ascites, repeated hospital admissions and prescription of low salt diet lead to significant reduction of dietary intake leading to malnutrition and sarcopenia. In addition, prolonged fasting in these patients leads to accelerated starvation, neo-glucogenesis and loss of muscle mass. Sarcopenia can be diagnosed by various clinical and radiological tests. Presence of sarcopenia has been associated with increased morbidity and short-term mortality. In addition, sarcopenia has been associated with increased morbidity and mortality in liver transplant recipients. The chapter aims to provide a brief overview regarding prevalence and etiopathogenesis of sarcopenia in patients with end-stage liver disease. In addition, diagnosis and management of sarcopenia will also be discussed. Management of sarcopenia will also be discussed briefly. Finally, clinical significance of sarcopenia and frailty in the setting of liver transplantation will also be discussed.