Would you refer an ESKD patient with an identified living donor for AV access placement if kidney transplantation is anticipated in 4 months?

Good question. I would not because it seems like it would only be a few months that the patient would be able to use the fistula, and I would spare them the surgery. One can make an argument, though, to place one as it may be needed if the transplant fails also. If there is a way one can move up the surgery date for a kidney transplant, that would be the best option. Also, if one can entirely avoid catheter placement, it may again be worthwhile.