A common lament is that long-term kidney transplant outcomes remain the same despite
improvements in early graft survival. To be fair, progress has been made—in both our
understanding of chronic injury and modestly, graft survival. However, we are still a long way
from actually solving this important and difficult problem. In this review, we outline recent
data supporting the existence of several causes of renal allograft loss, the incidences of
which peak at different time points after transplantation. On the basis of this broadened …