Cytomegalovirus (CMV) infection is a common complication following kidney transplantation resulting in significant morbidity, graft loss, and occasional mortality. Patients at high risk of CMV disease are CMV-seronegative recipients (R-) who receive an organ from CMV-seropositive donor (D+) and those receiving an intensive T-cell depleting induction immunosuppression. The diagnosis is based on the detection of viral replication by pp65 antigenemia or CMV DNAemia. Current preventive strategies in kidney transplant recipients include universal prophylaxis for 3–6 months after kidney transplantation or pre-emptive therapy with valganciclovir or intravenous ganciclovir. Established disease should be treated using either intravenous ganciclovir or oral valganciclovir until CMV replication can no longer be detected. Ganciclovir-resistance CMV, which consists of a lack of clinical or virological response to prolonged therapy due to viral gene mutations, is an emerging clinical challenge. In this review, we highlight the most relevant topics on CMV and kidney transplantation based on current evidence and guidelines.
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