FSGS is the most common glomerular disorder leading to ESRD in the pediatric population. FSGS accounts for approximately 10% of pediatric kidney transplant recipients. Patients with FSGS have increased morbidity and reduced overall graft survival secondary to disease recurrence. Predictor for FSGS recurrence include rapid progression to ESRD, poor response to therapy, younger age at diagnosis, presence of mesangial proliferation in the native kidney, recurrence in a previous kidney transplant, no NPHS 2 mutation and Caucasian race. The mechanism of recurrence thought to be related to circulating permeability factors that alter the permeability of the glomeruli within the allograft. Based on this hypothesis plasmapheresis (PP) is used as a treatment modality for recurrent FSGS in transplanted kidney. At UCLA we studied 30 patients with FSGS receiving transplant between January 1990 and August 2006. Twelve and 18 patients received living donor (LD) transplant and diseased donor (DD) transplant respectively. 14 patients received high dose cyclosporin while 16 patients received high dose tacrolimus. Pretransplant PP was done from 1-10 sessions for LD. 14 patients (54%) had recurrent nephrotic syndrome, 10 of 16 DD (63%) and 4 of 10 LD (40%). Among 18 DD 12 received high dose cyclosporin and 6 of 12 (50%) had recurrence. In contrast all of the 6 DD who received high dose tacrolimus had recurrence. Among 12 LD one of two patients who received high dose of cyclosporin had recurrence whereas 3 of 10 patients who received tacrolimus had recurrence. Ten of the 12 LD had pretransplant PP. 4 of 7 LD (57%) who received <5 sessions of pretransplant PP had recurrent nephrotic syndrome, whereas none of 5 LD who received >5 session of pretransplant PP had recurrence. We conclude that DD who received high dose of cyclosporin had decreased recurrence compared with patient on high dose tacrolimus. 4 LD patient with >5 pretransplant PP had less recurrence than patients with <5 sessions. In FSGS it is prudent to use high dose cyclosporin in DD. For LD use of more than 5 pretransplant PP may reduce recurrent nephrotic syndrome.