The benefits of low-density lipoprotein apheresis (LDL-A) for the treatment of recurrent focal segmental glomerulosclerosis (rFSGS) in pediatric kidney transplant recipients are uncertain. Although recurrent FSGS is one of the leading causes of graft loss in children after kidney transplantation, there is no standard of care for management, and clinical outcomes have been highly variable among pediatric kidney transplant recipients who have received plasmapheresis, rituximab, or intensified immunosuppression. LDL-A is an extracorporeal therapy approved by the FDA for the treatment of FSGS in children. LDL-A has been used on an individual basis in the transplant population, but its efficacy and role in the treatment of rFSGS have not been well established.

In a recent systematic review and meta-analysis, Dr. Priya Verghese and colleagues at Ann & Robert H. Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine aimed to determine the benefits of LDL-A for children with rFSGS. The team searched Ovid MEDLINE, CENTRAL, Embase, CINAHL, and Scopus (Updated May 14, 2024) for all available studies that included children (age <18 years) with rFSGS and treated with LDL-A. Seven studies were included that had 24 children who received a kidney transplant and were diagnosed with rFSGS. The quality of each study was assessed for bias and data quality, and outcomes were evaluated for remission at follow-up. Remission was defined by urine protein-to-creatinine (UPC) ratios at follow-up (complete remission, UPC <300 mg/g; partial remission, 300–3500 mg/g; no remission, UPC >3500 mg/g).

The outcomes were as follows: Complete Remission was observed in 46% of the patients; Partial Remission in 38%; and No Response to therapy in 16%. The overall response rate was 84%. In patients with follow-up of more than 6 months, the rates of Complete Remission and Partial Remission were even better (50% and 44%, respectively). The studies included in the analysis had a moderate to high risk of bias (as described in the flowchart). This is attributed to the small sample sizes as well as heterogeneity in the treatment regimens used (frequency of LDL-A and treatment duration; some studies used in combination with other immunomodulatory drugs). The collective outcome from all the studies indicates a reasonable degree of success for LDL-A as a potential adjunctive therapy in the management of post-transplant rFSGS. While the data are very encouraging, the review clearly calls for standardized LDL-A protocols and prospective multicenter studies to investigate further the ideal timing of treatment, the duration of treatment, and the definition of long-term outcomes. With rFSGS remaining a major post-transplantation challenge in pediatric renal transplantation, this review study reiterates the role of complementary innovative extracorporeal strategies, such as LDL-A, alongside existing immunosuppressive regimens, to improve graft survival and patient outcomes.

This review represents a significant step forward in consolidating global experience with LDL-apheresis in pediatric transplantation. It also aligns with the International Pediatric Transplant Association (IPTA)’s mission to promote evidence-based therapies and collaborative research. Interested investigators and clinicians are encouraged to engage in future multicenter efforts exploring LDL-A and other extracorporeal modalities in recurrent nephrotic syndrome and antibody-mediated renal diseases.

At the last IPTA Council meeting in Berlin, held during the 13th Congress of the International Pediatric Transplant Association, a new chapter for IPTA began: we are proud to announce the formation of the Careers and Mentoring Committee!

This committee is dedicated to fostering academic career development and mentoring within our community. Its mission is to guide the IPTA Council on matters related to professional growth, and to lead initiatives that strengthen the visibility, engagement, and advancement of early- and mid-career members. Through structured programs and active mentoring, the committee aims to create opportunities for learning, collaboration, and leadership — ensuring the next generation of pediatric transplant professionals can thrive.

The new committee continues and expands the IPTA Mentoring Program, which was initiated by Dr. Anette Melk, based on ideas from Dr. Luca Dello Strologo and Dr. Chesney Castleberry. The Careers and Mentoring Committee evolves from and replaces the previous Publication Committee, building on its mentoring initiatives and further strengthening IPTA’s commitment to career development and professional growth. In its first cycle, eight mentors and eight mentees took part. Four mentees received travel scholarships to the Berlin Congress, and six presentations were delivered — a strong testament to the power of mentorship within our field.

We are now preparing for the next cycle of the IPTA Mentoring Program, and warmly invite both mentors and mentees to take part! To apply, please contact: ipta-mentoring@mh-hannover.de

The multi-organ transplant (MOT) committee, currently in its third year, has 16 committee members who are tasked to explore issues related to multiorgan/multivisceral transplantation in the pediatric transplant population. This past year, we presented a literature review titled “The Pediatric Intestine-Inclusive Multiorgan Transplant” in the spring and submitted 3 session proposals for the annual meeting in Berlin, of which 1 was accepted. At the Berlin meeting, MOT held an in-person MOT committee meeting and strategized 2026 project proposals, which include creation of a potential multi-organ listserv for peer-review of complex multiorgan cases, sponsorship of a multi-visceral webinar, and creation of a research project focused on combined organ transplant in very young children. If you are interested in working on either of the upcoming projects or would like to join the community once it is established, please reach out to Irene Kim (Irene.Kim@cshs.org) or Alisha Mavis (Alisha.Mavis@advocatehealth.org).