Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience I.K. Bulut a, *, S. Taner a , A. Keskinoglu a , H. Toz b , B. Sarsik c , T.O. Sezer d , and C. Kabasakal a a Department of Pediatric Nephrology, Ege University Faculty of Medicine, _ Izmir, Turkey; b Department of Nephrology, Ege University Faculty of Medicine, _ Izmir, Turkey; c Department of Pathology, Ege University Faculty of Medicine, _ Izmir, Turkey; and d Department of General Surgery, Ege University Faculty of Medicine, _ Izmir, Turkey ABSTRACT Introduction and Aim. Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. Materials and Method. This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. Results. Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10- year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. Conclusion. This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required. N EPHROTIC syndrome, with an incidence of 2e16.9 per 100,000 children worldwide, is one of the most com- mon glomerular diseases of childhood [1]. Focal segmental glomerulosclerosis (FSGS) manifesting as nephrotic syn- drome is a clinicopathologic diagnosis characterized by segmental sclerosis in some glomeruli; the majority of such patients are resistant to steroid therapy [2]. According to the 2014 North American Pediatric Renal Transplant Coopera- tive Study (NAPRTCS) data, FSGS is the most prevalent acquired renal disease among transplant recipients [3]. While the rate of recurrence ranged between 20%e50%, graft loss was reported to be 30%e50% in earlier studies. High rates of recurrence and graft loss prove that there are unexplained factors in the pathogenesis of the disease [4e6]. In this study we analyzed the long-term outcome of FSGS patients undergoing renal transplantation in our center. The objectives of the study are first to report on 27 years of experience of a single center and second to determine the incidences of recurrence, rejection, graft loss, and related risk factors. MATERIALS AND METHODS Patients Between November 1991 and September 2018, 205 children (<18 years of age) underwent renal transplantation at Ege University *Address correspondence to Ipek Kaplan Bulut, MD, Depart- ment of Pediatric Nephrology, Ege University Faculty of Medi- cine, 35100 _ Izmir, Turkey. Tel: þ90 232 390 1005. E-mail: ikaplanbulut@gmail.com 0041-1345/19 https://doi.org/10.1016/j.transproceed.2019.01.096 ª 2019 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 1064 Transplantation Proceedings, 51, 1064e1069 (2019)