Use of sirolimus after kidney transplantation is associated with a reduced risk of malignancy but an increased overall risk of death, according to findings of a systematic review and meta-analysis. Knoll and colleagues analysed data from 5,876 participants of randomized controlled trials that compared immunosuppressive regimens with and without sirolimus. Sirolimus use was associated with a 40% reduction in the risk of malignancy and a 56% reduction in the risk of nonmelanoma skin cancer, but an increased risk of death (HR 1.43, 95% CI 1.21–1.71) compared with controls.