Focal segmental glomerulosclerosis (FSGS) is a devastating kidney disease with a high rate of progression to end stage kidney failure. After kidney transplant, the idiopathic form of FSGS has a high rate of recurrence, with earlier allograft loss if remission is not achieved. Multiple therapies have been tried, with variable success rates, and studies are difficult because the recurrent disease is rare for any one center. National data are sparse but 2 recent collaborations (TANGO and PedsNet) provide further insight. In the proposed session, the moderator Dr. Dharnidharka (who leads the PedsNet collaboration) will engage the expert panelists (Dr. Riella represent TANGO, Dr. Gheith represents the Middle East experience, Dr. Obeid presenting an abstract on pediatric kidney transplants at TTS) in a detailed discussion of the therapies available, and their efficacy and risk comparisons. The team will also discuss the imperative for future studies.