Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children

The incidence of recurrence of nephrotic syndrome/focal segmental glomerulosclerosis (NS/FSGS) is variable (~30%)The incidence of recurrence is less in African-Americans than in whites and HispanicsGraft survival rates are decreased in recipients with FSGS, especially if remission of the NS is not achieved in those with recurrenceAlthough controversial, the use of living donor (LD) transplants are not contraindicated; however, obligatory heterozygote parental grafts with a podocin mutation should be used with cautionOptimal treatment to induce a remission post-transplant has not been delineatedPre-transplant and/or prophylactic post-transplant pre-operative plasmapheresis (PP) for high-risk patients—especially those with recurrence in a previous graft—may be promisingAn international multicenter controlled study is required to delineate the optimal approach to prevent and/or treat the recurrence of NS/FSGS