Background: In this study, our aim is to investigate the prognostic value of psoas muscle area (PMA) evaluation before liver transplantation (LT) in pediatric patients. Methods: Two hundred seventy-six patients under 18 years of age who underwent LT between January 2012 and December 2019 were included in the study. The patients’ demographic, laboratory, clinical, and imaging data were scanned retrospectively. PMA was measured at the L4/5 level using computed tomography images. To determine reproducibility, a different radiologist evaluated 30 randomly selected patients. Results: In patients with end-stage liver disease (ESLD), PMA was significantly lower than in patients with acute liver failure (P <.001). In patients with ESLD, a weakly significant correlation was found between PMA and 1-year survival after LT (r:.251, P =.030), hospitalization period (r: −.275, P =.039), and pediatric ESLD score (r: −.338, P <.001). Interobserver correlation was excellent (ICC:.941, 95% CI:.925,.971). Conclusion: In children with ESLD, PMA evaluated before LT can be used as a negative prognostic factor.