Objective: To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods: We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results: Ten studies (1 121 patients) undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and blinding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR (95% CI) values were 0.77(0.17, 3.52), 1.24(0.48, 3.16), 1.32(0.57, 3.08), 1.21(0.60, 2.41) at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR (95% CI) values were 1.79(0.63, 5.06), 1.15(0.56, 2.36), 1.39 (0.68, 2.85), 1.80(0.99, 3.29), 2.13(1.16, 3.89), 2.01(1.15, 3.51) at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OR (95% CI) values were 0.92(0.48, 1.78), 1.90(1.25, 2.89), 2.01(0.94, 4.27), 1.93(0.93, 4.00), 1.52(0.77, 3.02) at the end of 6, 12, 24, 36, 48 months respectively. Conclusions: Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.