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Volume 358:2518-2520 June 5, 2008 Number 23
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Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation

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by Ekberg, H.
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To the Editor: Ekberg et al. (Dec. 20 issue)1 report the results of the Efficacy Limiting Toxicity Elimination (ELITE)–Symphony trial, in which they evaluated reduced exposure to calcineurin inhibitors in patients undergoing renal transplantation. The authors' putative conclusion is that a quadruple immunosuppressive regimen of daclizumab, "low-dose" tacrolimus, mycophenolate mofetil, and corticosteroids should be considered the standard in renal transplantation. We have concerns, however, about the equipotency of the four immunosuppressive strategies used. The trough levels of sirolimus that were achieved in the calcineurin-inhibitor–free group have not been demonstrated to be clinically effective and are, in our view, probably too . . . [Full Text of this Article]



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