Purpose: Frailty is a clinical condition characterised by loss of physiologic reserve and increased susceptibility to stressors. Incidence of frailty is increased in patients with cirrhosis compared to healthy elderly adults and has been associated with adverse outcomes in liver transplant candidates. This study aimed to assess multiple clinical frailty assessments and biomarkers of cellular ageing as predictors of clinical outcomes. Methods: 50 patients were prospectively evaluated while undergoing liver transplant assessment. Clinical assessments included Liver Frailty Index (LFI), Fried Frailty Index (FFI), and Rockwood Frailty Score (RFS). Assessments were repeated at 3-monthly intervals whilst wait-listed and post-transplant. Relative telomere length (RTL) was measured using qPCR. Outcomes included decompensation-related hospitalisations, time on the waiting-list and post-transplant outcomes Results: The prevalence of clinical frailty ranged from 20% to 37%, depending on the frailty score. MELD-Na was associated with increased RFS (rs=0.244, p=0.032). FFI was significantly higher in patients admitted with hepatic encephalopathy (mean rank=18.56), compared to those without admission (mean rank 29.80, U=134, p=0.039). There was no significant associated between RTL and frailty measure or age, but there was a trend towards reduced RTL and both increased age (rs=-0.244, p=0.088) and increased frailty (LFI rs=-0.2, p=0.164, FFI rs=-0.131, p=0.368, RFI rs=-0.112, p=0.438). Conclusions: Frailty was associated with both increased MELD-Na and Child-Pugh score. Frailty was also increased in patients admitted to hospital with HE. This is the first time telomere length has been investigated in this cohort of patients in regards to frailty, and demonstrates a negative correlation between the two.