*Purpose: The aim of this study is to compare the efficacy and safety of SRL versus EVR versus MPA in kidney transplant recipients.

*Methods: This is a single center, prospective and randomized trial in kidney transplant recipients receiving a single 3 mg/kg dose of r-ATG induction therapy, tacrolimus and faster prednisone taper (Clinicaltrials.govNCT03468478). Randomized patients receive SRL (3mg QD adjusted to maintain concentrations between 4 to 8 ng/mL), EVR (3mg BID adjusted to maintain concentrations between 4 to 8ng/mL), or MPA (720 mg BID). All patients received preemptive treatment for CMV infection. The primary endpoint was the incidence of CMV infection at 12 months.

*Results: This analysis includes data from 267 kidney transplants recipients receiving SRL(n=87), EVR(n=91), or MPA(n=89). Key efficacy and safety outcomes are shown in Table. The incidence of CMV infection was lower in SRL and EVR groups compared to MPA group but there were no differences in the proportion of patients with CMV specific cellular immunity based on the Quantiferon (QTF) test or with BKV viremia. There was no difference in the incidence of biopsy proven acute rejection (BPAR), incidence of de novo DSA, graft loss or death. At 12 months, there was no difference in renal function or in Banff scores of protocol biopsies. Conclusions: These data confirms and expands previous observations regarding the comparable efficacy of mTOR inhibitors and lower incidence of CMV infection.

*Conclusions: .

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