| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated | 
| Liver transplantation |  
| lever transplantatie |  | 
| E.1.1.1 | Medical condition in easily understood language | 
| Liver transplantation |  
| Lever transplantatie |  | 
| E.1.1.2 | Therapeutic area | Not possible to specify | 
| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| 
| E.1.2 | Version | 19.0 |  
| E.1.2 | Level | LLT |  
| E.1.2 | Classification code | 10050434 |  
| E.1.2 | Term | Prophylaxis against liver transplant rejection |  
| E.1.2 | System Organ Class | 100000004865 |  | 
| E.1.3 | Condition being studied is a rare disease | No | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial | 
| Main objective is to compare the both therapy regimens with regard to effectiveness and safety (renal function) |  | 
| E.2.2 | Secondary objectives of the trial | 
| Secondary objectives are: compare incidence of de novo malignancy at month 36 after transplantation
 compare incidence and severity of BPAR at month 12, 24 and 36
 evaluate renal function
 evaluate development of NODM at month 12, 24 and 36
 evaluate the prevalence of side effects at month 12, 24 and 36
 evaluate quality of life
 evaluate the percentage of treatment switchers
 |  | 
| E.2.3 | Trial contains a sub-study | No | 
| E.3 | Principal inclusion criteria | 
| •	Primary liver transplantation or retransplantation within 14 days after first transplantation •	Use of Advagraf at least 2 weeks prior to randomization
 •	Patent hepatic artery
 •	Closed abdominal wound
 •	Stable graft function
 •	Positive informed consent at time of randomization
 •	Age 18-70 years
 
 |  | 
| E.4 | Principal exclusion criteria | 
| •	Treatment with investigational drugs within 3 months before start of therapy •	Multi organ transplantation
 •	cGFR < 30 ml/min
 •	Proteinuria > 800 mg/24 h
 •	Hypersensitivity to sirolimus
 •	Thrombocytes < 50 x 109 /L
 •	Leukocytes < 2.5 x 109 /L
 •	Haemoglobin < 6 mmol/L
 •	Biopsy proven rejection 2 weeks  prior to randomization
 •	HIV positivity
 •	Signs of recurrent or de novo cancer
 •	Pregnancy or breast feeding
 •	Systemic infection
 •	Any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the study
 
 |  | 
| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| •	Percentage of patients with cGFR < 60ml/min at 36 months after transplantation 
 |  | 
| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
| 3 years after transplantation |  | 
| E.5.2 | Secondary end point(s) | 
| • Incidence of de novo malignancy at 36 months after transplantation • Incidence of and time to recurrent malignancy
 • Biopsy proven rejection
 • Retransplantation
 • Percentage of patients with cGFR <60ml/min at 12 and 24 months after transplantation
 • Incidence of de novo diabetes mellitus at 12, 24 and 36 months after transplantation
 • Quality of life using Eq5D questionnaires at 12, 24 and 36 months after transplantation
 • Severity of fatigue using FSS at 12, 24 and 36 months after transplantation
 • Safety (serious adverse events)
 • Tolerability of combination sirolimus and extended release tacrolimus
 • Percentage of patients on combination sirolimus and extended release tacrolimus converted to monotherapy extended release tacrolimus due to lack of tolerability or efficacy of combination sirolimus and extended release tacrolimus.
 |  | 
| E.5.2.1 | Timepoint(s) of evaluation of this end point | 
| 12, 24 and 36 months after transplantation |  | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis | No | 
| E.6.2 | Prophylaxis | Yes | 
| E.6.3 | Therapy | Yes | 
| E.6.4 | Safety | Yes | 
| E.6.5 | Efficacy | Yes | 
| E.6.6 | Pharmacokinetic | No | 
| E.6.7 | Pharmacodynamic | No | 
| E.6.8 | Bioequivalence | No | 
| E.6.9 | Dose response | No | 
| E.6.10 | Pharmacogenetic | No | 
| E.6.11 | Pharmacogenomic | No | 
| E.6.12 | Pharmacoeconomic | No | 
| E.6.13 | Others | No | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) | No | 
| E.7.1.1 | First administration to humans | No | 
| E.7.1.2 | Bioequivalence study | No | 
| E.7.1.3 | Other | No | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) | No | 
| E.7.3 | Therapeutic confirmatory (Phase III) | Yes | 
| E.7.4 | Therapeutic use (Phase IV) | No | 
| E.8 Design of the trial | 
| E.8.1 | Controlled | Yes | 
| E.8.1.1 | Randomised | Yes | 
| E.8.1.2 | Open | Yes | 
| E.8.1.3 | Single blind | No | 
| E.8.1.4 | Double blind | No | 
| E.8.1.5 | Parallel group | Yes | 
| E.8.1.6 | Cross over | No | 
| E.8.1.7 | Other | No | 
| E.8.2 | Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) | Yes | 
| E.8.2.2 | Placebo | No | 
| E.8.2.3 | Other | No | 
| E.8.2.4 | Number of treatment arms in the trial | 2 | 
| E.8.3 | The trial involves single site in the Member State concerned | No | 
| E.8.4 | The trial involves multiple sites in the Member State concerned | Yes | 
| E.8.4.1 | Number of sites anticipated in Member State concerned | 3 | 
| E.8.5 | The trial involves multiple Member States | No | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA | No | 
| E.8.6.2 | Trial being conducted completely outside of the EEA | No | 
| E.8.7 | Trial has a data monitoring committee | No | 
| E.8.8 | Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial |  | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 10 | 
| E.8.9.1 | In the Member State concerned months | 0 | 
| E.8.9.1 | In the Member State concerned days | 0 |