Summary: Cytomegalovirus remains the most significant infectious pathogen in transplant recipients. It causes both direct (CMV disease) and indirect effects, including allograft injury, post-transplant diabetes mellitus, malignancies (post-transplant lymphoproliferative disorder, PTLD), cardiovascular complications, opportunistic infections leading to reduced patient and graft survival. Renal transplant recipients develop CMV infection either as asymptomatic or as symptomatic disease with attributable clinical presentation. Currently used antiviral drugs against CMV infection in renal transplant patients include: ganciclovir, valganciclovir, cidofovir and foscarnet. The treatment options for CMV infection are: preemptive therapy, treatment of symptomatic infection or CMV disease, and dose reduction of the immunosuppressive therapy. Prevention of CMV especially in seronegative transplant recipients is also recommended. Both prophylaxis and preemptive therapy are effective in reducing the rate of CMV disease and mortality. A new challenge is delayed onset CMV disease revealing after termination of CMV prophylaxis. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation that summarizes the updated recommendations was published in 2018.