*Purpose: Recurrence of focal segmental glomerulosclerosis (FSGS) has been reported between 20-80% with up to 60% of graft loss. Rituximab has demonstrated to be effective in preventing recurrence but this disease management remains a challenge. We aimed to describe our single center experience using Rituximab to induction immunosuppression (IS) with and without steroids free maintenance protocols.

*Methods: This is a retrospective review of kidney transplant recipients (KTR) with biopsy proven primary FSGS performed in our center from January-December 2017. Recurrence of FSGS was defined as urine protein creatinine ratio(UPCR) ≥3gr/day at any point of time during 1 year follow up. Patient and transplant baseline characteristics, serum creatinine(Scr) and eGFR at 12 months (m) were analyzed. All KTR received induction immunosuppression (IS) with anti-thymocyte globulin 1 mg/kg x 3, Basiliximab 2mg x 2, steroids and Rituximab 375 mg/m2 x 1. Maintenance Immunosuppression with tacrolimus (target trough level 6-8ng/ml), mycophenolate mofetil 720 mg twice daily with or without steroids.

*Results: 23 KTR: 18 (78%) male and 5 (22%) female with mean age 36 (range 20-50 y.o). 12 (52.2%) were African American, 4 (17.5%) Caucasian, 6 (26%) Hispanic and 1(4.3%) Asian descendant. 13 KTR(57%) received maintenance IS with steroids and 10 (43%) steroid free protocol. 3 (13%)KTR had recurrence FSGS, 2 of them were on the steroid free protocol (p=0.55). The mean Scr and eGFR at 12m were 1.34mg/dl and 70 ml/min, respectively. Graft and patient survival were 100% at 12m including those with recurrence who underwent treatment

*Conclusions: The addition of rituximab to our induction IS resulted in a low recurrence rate of 13% in adult KTR with primary FSGS leading to 100% graft and patient survival with preserve eGFR at 12 m. The use of steroids was not statistically significant due to our limited cohort.

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