Immunosuppressants have long been the cornerstone of success in transplantation. However, if long-term graft survival rates are to improve, new drugs with unique targets and improved efficacy, tolerability and synergy with existing immunosuppressants are required. This was the main idea presented by Dr Barry Kahan from the University of Texas Medical School, Houston, US, speaking on new targets of immunosuppression at the Horizons in transplantation symposium at the European Society of Organ Transplantation (ESOT) [Venice, Italy; September 2003]. Dr Kahan summarised the progression of drug development to date, including calcineurin inhibitors and agents such as mycophenolate mofetil and sirolimus, before discussing some of the new drugs under development for transplantation. One new drug that received attention at the ESOT meeting was the malononitrilamide FK 778, particularly with the presentation of the final results from the European proof of concept study in renal transplant recipients.