Background: The identification of individuals who will benefit most from kidney transplantation is challenging, with no clear consensus as to which clinical features provide the most prognostic information. Recently, computed tomography (CT)-diagnosed sarcopenia has proven to be accurate in predicting poorer outcomes solid organ transplant recipients. This systematic review and meta-analysis evaluates the role of sarcopenia, as defined by pre-operative CT, in the prediction of post-operative recipient and allograft outcomes in patients undergoing kidney transplantation. Methods: A comprehensive literature search was performed on Medline, Embase, Google Scholar and CINAHL databases. Seven articles involving 1153 patients were included in this review. Results: There was strong evidence to suggest that CT-defined sarcopenia was associated with increased mortality (OR 2.72, 95% CI 1.66 – 4.47, p<0.0001) and greater likelihood of readmission (OR 1.98, 95% CI 1.34 – 2.92, p=0.00006). There was a lack of evidence to support the use of pre-operative CT to define sarcopenia as a prognostic factor for allograft and other post-operative outcomes following kidney transplantation. Conclusions: This systematic review and meta-analysis demonstrates evidence to suggest pre-transplant sarcopenia identified on CT imaging is predictive of increased mortality and readmission. Given the limitations of evidence related to risk of bias and heterogeneity, there is a need for more robust prospective research to elucidate the true effect of CT diagnosed sarcopenia as a prognostic factor in the kidney transplant setting.