*Purpose: Recurrent focal segmental glomerulosclerosis(FSGS) is common after kidney transplantation . We conducted a retrospective cohort study with the aim to investigating the risk factors of recurrent FSGS after kidney transplantation and outcome of treatments for recurrent FSGS.

*Methods: We retrospectively collected 92 kidney transplant recipients with FSGS as the primary disease from January 2005 to December 2014. The patients were followed up for at least 5 years. Baseline characteristics including age, gender, proteinuria level, progress of primary FSGS were recorded. Proteinuria levels after transplant were monitored, and recurrent FSGS was diagnosed by allograft biopsy when proteinuria reappeared. The treatments for FSGS were also recorded.

*Results: 34(37.0%) patients suffered recurrent FSGS after kidney transplantation, which was diagnosed by allograft biopsy. Proteinuria was found in all patients with recurrent FSGS, and the mean proteinuria level was 4.21 g/ 24hours. Kaplan-Meier analysis showed that the 1-, 5-, and 10-year death censored graft survivals were much lower in recurrent FSGS recipients compared to non-recurrent FSGS recipients (97.1%, 47.1% and 28% vs. 100%, 87.9%, and 58.9%, p<0.05). Among recurrent FSGS patients, 22 patient received plasmapheresis. Kaplan-Meier analysis showed that the median graft survival time was much longer in patients received plasmapheresis, compared to patients who did not received plasmapheresis (7.32 years vs. 4.5 years, p<0.05) . Logistic multivariate regression showed that young age (<18 years old), proteinuria more than 7g/24h before transplant, and rapid progress of primary FSGS(<3 year from onset to uremia) were independent risk factors for recurrent FSGS (p<0.05).

*Conclusions: Young age, heavy proteinuria before transplant, and rapid progress of primary FSGS are independent risk factors for recurrent FSGS. Plasmapheresis may improve the outcome of recurrent FSGS.

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