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Immunosuppression strategies are needed to balance risks of acute and subclinical rejection with long\u2010term benefits of improved kidney function. Sirolimus, an inhibitor of mammalian target of rapamycin, is used for immunosuppression in kidney transplantation. Its clinical utility has evolved, over more than 15\u00a0years, including de novo sirolimus with and without concomitant <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>s and conversion from <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>\u2010based regimens to sirolimus. Sirolimus\u2010containing regimens are associated with preservation of good renal function, with promising characteristics for improving long\u2010term graft and patient survival, including antiviral and anticancer effects. Based on clinical evidence, use of low\u2010dose sirolimus in a de novo approach with tacrolimus\/steroids in the immediate posttransplantation period is appropriate. A feasible alternative is a long term, <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>\u2010free combination with mycophenolate mofetil (following <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>\u2010to\u2010sirolimus conversion at 3\u20106\u00a0months). These strategies are appropriate for a broad range of patients with various levels of immunologic risk, including those receiving expanded criteria donor kidneys or at increased risk of delayed graft function, particular challenges in Latin America and other global regions.<\/jats:p>","DOI":"10.1111\/ctr.13464","type":"journal-article","created":{"date-parts":[[2018,12,13]],"date-time":"2018-12-13T11:49:26Z","timestamp":1544701766000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Optimizing the clinical utility of sirolimus\u2010based immunosuppression for kidney transplantation"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9896-323X","authenticated-orcid":false,"given":"Helio","family":"Tedesco\u2010Silva","sequence":"first","affiliation":[{"name":"Divis\u00e3o de Nefrologia Hospital do Rim Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo 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