Cytomegalovirus (CMV) is the most frequently occurring opportunistic pathogen and single most important infectious agent in renal transplant recipients, contributing significantly to their morbidity and mortality. Infection generally occurs in the first four months after transplant and develops in about two-thirds of these patients overall. Cytomegalovirus infection may occur as a primary disease, a reactivation, or as a superinfection and may encompass a spectrum of diseases ranging from asymptomatic to fatal. This study reviews CMV donor and recipient status, prophylaxis, rejection episodes, immunosuppression and subsequent development of disease in 100 transplant cases in 98 patients which were performed at the charleston Area Medical Center between September 1987 and August 1991, and contrasts these findings to those from larger centers. Sixty-five recipients were positive for cytomegalovirus serologically at the time of transplantation, and of the 35 patients who were CMV negative, 20 received a kidney from a CMV-positive donor and a total of six patients have developed symptomatic disease to date.