When do you recommend genetic testing prior to kidney transplantation for a patient with ESKD secondary to FSGS?

This is a very important question especially as the cost of genetic testing is now much more affordable with commercially available kit. Genetic FSGS carries a much more favorable prognosis post transplant as recurrence would be very unlikely (with very rare exceptions). We would advise this I situations were secondary fsgs is less likely - typically be in a younger patient, strong family history of kidney disease, with other history and kidney biopsy findings not suggestive of secondary FSGS.

W...

Agree with Dr. @Dr. First Last's assessment. If a transplant candidate has clear evidence of secondary causes of FSGS (weight-based, medications, infections, autoimmune) and biopsy showed only patchy podocyte effacement, then I do not think the genetic testing would add much. The post-transplant monitoring presumable would be similar with those either with or without a genetic etiology, so where genetic testing would add value is that if you could prevent unnecessary interventions for genetic fo...