The ELITE-Symphony study aimed to evaluate the efficacy and toxic effects of four immunosuppressive regimens in renal transplantation, focusing on reducing exposure to calcineurin inhibitors. The study randomly assigned 1645 renal-transplant recipients to receive either standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids, or daclizumab induction, mycophenolate mofetil, and corticosteroids combined with low-dose cyclosporine, tacrolimus, or sirolimus. The primary endpoint was estimated glomerular filtration rate (GFR) 12 months post-transplantation, while secondary endpoints included acute rejection and allograft survival. Key findings include: - The mean GFR was higher in patients receiving low-dose tacrolimus (65.4 ml/min) compared to other groups (56.7 to 59.4 ml/min). - The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (12.3%) compared to standard-dose cyclosporine (25.8%), low-dose cyclosporine (24.0%), and low-dose sirolimus (37.2%). - Allograft survival differed significantly among the four groups, with the low-dose tacrolimus group showing the highest survival rate (94.2%), followed by the low-dose cyclosporine group (93.1%), standard-dose cyclosporine group (89.3%), and low-dose sirolimus group (89.3%). - Serious adverse events were more common in the low-dose sirolimus group (53.2%) compared to other groups, but the overall proportion of patients with at least one adverse event was similar across all groups. The study concluded that a regimen combining daclizumab, mycophenolate mofetil, and corticosteroids with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates compared to other regimens. Despite improved short-term outcomes, long-term allograft nephropathy and death remain significant concerns.The ELITE-Symphony study aimed to evaluate the efficacy and toxic effects of four immunosuppressive regimens in renal transplantation, focusing on reducing exposure to calcineurin inhibitors. The study randomly assigned 1645 renal-transplant recipients to receive either standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids, or daclizumab induction, mycophenolate mofetil, and corticosteroids combined with low-dose cyclosporine, tacrolimus, or sirolimus. The primary endpoint was estimated glomerular filtration rate (GFR) 12 months post-transplantation, while secondary endpoints included acute rejection and allograft survival. Key findings include: - The mean GFR was higher in patients receiving low-dose tacrolimus (65.4 ml/min) compared to other groups (56.7 to 59.4 ml/min). - The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (12.3%) compared to standard-dose cyclosporine (25.8%), low-dose cyclosporine (24.0%), and low-dose sirolimus (37.2%). - Allograft survival differed significantly among the four groups, with the low-dose tacrolimus group showing the highest survival rate (94.2%), followed by the low-dose cyclosporine group (93.1%), standard-dose cyclosporine group (89.3%), and low-dose sirolimus group (89.3%). - Serious adverse events were more common in the low-dose sirolimus group (53.2%) compared to other groups, but the overall proportion of patients with at least one adverse event was similar across all groups. The study concluded that a regimen combining daclizumab, mycophenolate mofetil, and corticosteroids with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates compared to other regimens. Despite improved short-term outcomes, long-term allograft nephropathy and death remain significant concerns.