Purpose of reviewRecent publications have focused on the results of phase I and phase II everolimus clinical trials in renal transplantation. This review will focus both on the pharmacokinetics of everolimus and on its use as an immunosuppressive agent in phase III clinical trials in solid multiorgan transplantation.Recent findingsPhase III clinical trials with long-term follow-up (3 years) have demonstrated that everolimus is a potent immunosuppressive agent. It appears to be well tolerated, with a good safety profile, and has been shown to be effective in solid multiorgan transplant recipients; it has also been effective in cyclosporine-sparing protocols. Everolimus has also been demonstrated to inhibit smooth muscle proliferation, obliterative arteriopathy, transplant arteriosclerosis, and posttransplant lymphoproliferative disorder-derived cellsin vitroandin vivo.SummaryEverolimus, like sirolimus, appears to allow for calcineurin inhibitor minimization, which may allow less nephrotoxicity without compromising efficacy. It appears to protect against CMV infection, and the potential antitumor and antiproliferative activity in in-stent neointimal growth may have significant clinical benefits.