BACKGROUND: Recurrence of focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a frequent and still unpredictable complication. Moreover, risk factors for recurrence have not yet been clearly identified. METHODS: We enrolled into our study 2,882 adult kidney recipients who underwent transplantation between April 1979 and April 2009. We retrospectively reviewed clinical manifestations of recurrence of FSGS. RESULTS: Among the 2,784 adult renal recipients, forty four had undergone renal transplantation for primary FSGS. Of the 44, 12 (27.3%) showed recurrent FSGS. Mean duration between transplantation and FSGS recurrence was 22.8+/-37.4 months. There were no significant differences in patient characteristics in the recurrence and non-recurrence groups. The cumulative incidence of FSGS recurrence was 13.8% within 1 year after kidney transplantation and 23.2% within 3 years. The overall graft survival rate in the recurrence group was significantly lower than that of the non-recurrence group (P=0.0018) and non-FSGS group (P=0.0001). Graft failure happened more in the recurrence group (75%) than in the non-recurrence group (37.5%, P=0.042). CONCLUSIONS: We failed to find any significant risk factors for FSGS recurrence after renal transplantation.