The FRAILMar trial addresses a growing challenge in kidney transplantation: how to optimize candidates, particularly those with frailty, during the vulnerable and oftentimes prolonged pre-transplant period to mitigate post-operative risks. Defined by reduced physiologic reserve and increased vulnerability to stressors, frailty is highly prevalent in individuals with end-stage kidney disease (ESKD). Frailty is independently associated with increased risks of pre-1–3 and post-kidney transplant (KT) adverse outcomes.