Cytomegalovirus (CMV) continues to be responsible for a substantial fraction of the morbidity and mortality that follows organ transplantation. The three major consequences of CMV infection are CMV disease (encompassing a range of clinical illness), superinfection with opportunistic pathogens, and injury to the transplanted organ. In the last decade, considerable progress has been made in elucidating risk factors for CMV disease, in rapid detection of CMV in clinical specimens, and in the use of antiviral chemotherapy and immunoglobulin to prevent and treat CMV disease after transplantation. This article discusses the impact of these advances on patient outcome following transplantation and the challenges for the next decade.