As a hospitalist on the Medical Transplant team who sees kidney and/or pancreas transplant patients, I come across many cases of chronic allograft nephropathy, which has been identified as the most common cause of re-transplantation and the fourth-leading cause of dialysis after successful transplantation. Small case studies have demonstrated that such patients with allograft nephropathy may benefit from the discontinuation of calcineurin inhibitors, like tacrolimus and cyclosporine, and substitution with sirolimus.