Recurrence of primary disease is one of the major risks for allograft loss after pediatric RTx. The risk of recurrence of FSGS/SRNS after pediatric RTx in particular can be up to 86% in idiopathic cases. There is a need for consensus recommendations on its prevention and treatment. The CERTAIN study group has therefore performed a thorough literature search based on the PICO model of clinical questions to formulate educated statements to guide the clinician in the process of decision-making. A set of educated statements on prevention and treatment of FSGS/SRNS after pediatric RTx has been generated after careful evaluation of available evidence and thorough panel discussion. We do not recommend routine nephrectomy prior to transplantation; neither do we recommend abstaining from living donation. Special attendance needs to be given to those patients who had already experienced graft loss due to FSGS/SRNS recurrence. Early PE or IA with or without high-dose CsA and/or rituximab seems to be most promising to induce remission. The educated statements presented here acknowledge that FSGS/SRNS recurrence after pediatric RTx remains a major concern and is associated with shorter graft survival or even graft loss. The value of any recommendation needs to take into account that evidence is based on cohorts that differ in ethnicity, pre-transplant history, immunosuppressive regimen, definition of recurrence (eg, clinical and/or histological diagnosis) and treatment modalities of recurrence.

1st Pediatric Department Pediatric Nephrology Unit Hippokration General Hospital Aristotle University Thessaloniki Greece

Department of Nephrology and Transplantation Children's Health Ireland Dublin Ireland

Department of Nephrology Kidney Transplantation and Hypertension The Children's Memorial Health Institute Warsaw Poland

Department of Pediatric Nephrology Amsterdam University Medical Center Emma Children's Hospital Amsterdam The Netherlands

Department of Pediatric Nephrology School of Medicine Hacettepe University Ankara Turkey

Department of Pediatrics 2 University Hospital of Essen University Duisburg Essen Essen Germany

Department of Pediatrics 2nd Medical Faculty Charles University Prague Prague Czech Republic

Department of Pediatrics Dr von Hauner Children's Hospital University Hospital LMU Munich Munich Germany

Department of Pediatrics University Children's Hospital Heidelberg Heidelberg Germany

Department of Pediatrics University Medical Center Hamburg Eppendorf University of Hamburg Hamburg Germany

Faculty of Medicine University Hospital of Cologne Children's and Adolescents' Hospital Pediatric Nephrology University of Cologne Cologne Germany

Pediatric Nephrology and Rheumatology Department Ghent University Hospital Ghent Belgium

Pediatric Nephrology Department Children's Hospital University Medical Centre Ljubljana Ljubljana Slovenia

Pediatric Renal Transplant Unit Bambino Gesù Children's Research Hospital IRCCS Rome Italy

UCL Great Ormond Street Institute of Child Health NIHR Great Ormond Street Hospital Biomedical Research Centre London UK

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