Alefacept is not associated with a reduced incidence of biopsy-confirmed acute T-cell-mediated rejection, say the authors of a recent randomized controlled trial. Rostaing et al. randomly assigned de novo renal transplant recipients to receive alefacept (n = 105) or placebo (n = 107). They found that memory-T-cell counts were decreased between 3 weeks and 6 months in the alefacept group, but found no difference in the incidence of acute T-cell-mediated rejection at 6 months. Patient and graft survival were similar in the two groups, as were safety and tolerability, although malignancy rate was higher in patients treated with alefacept.