Routine prophylaxis to prevent CMV disease has been widely advised. We evaluate standard care based upon regular clinical assessment with treatment of symptomatic CMV infection as an alternative to prophylaxis.We analyzed 355 consecutive RT (96% cadaveric donor) without prophylaxis for CMV. 61% males. Age: 46±12y. 4.6% were highly sensitized and 14% second RT. Pre-RT CMV serology: D-/R-:9.4%, D+/R-:13.7%, D-/R+:15.8%, D+/ R+: 61.1%. Induction treatment: Thymoglobulin: 13%, Atgam: 35%, Zenapax/Simulect: 21%, OKT3:32%; CyA:75%, FK:24.7% Aza: 5.6% MMF: 48% and steroids: 100%. Mean follow-up: 10.9±2.7y. Treated acute rejection: 18% of pats. CMV occurred in 67 pats (18.8%). 45 pats (66%) and 22 pats (34%) developped CMV infection and disease respectively. 21% were HCV+ vs 11.8% in those without CMV infection. CMV was treated with i.v.Ganciclovir during 15-21days. Opportunistic infections occurred in 13 (19%) CMV pats (3 Pneumocistis, 3 TBC, 2 Leishmania, 2 Legionella, 1 aspergillus, 2 other) and in 9 (3.1%) pats without CMV (p=0.002) Cancer occurred in 10,4% of pats with CMV and in 8.3% of pats without CMV (p:ns). CMV recurred in 3 pats that were succesfully treated. No one of the 67 pats with CMV infection died. At 10.9y. patient and graft survival in CMV pats was 88% and 45% respectively, and 87.5% and 46% in no CMV pats. S.Cr and proteinuria in pats with CMV: 2.26±0.8 mg/dl, and 352±268 mg/d, and in those without CMV: 1.96±0.6 mg/dl (p=0.03) and 282±189 mg/day (p=ns) Despite the universal administration of induction therapy our CMV incidence is comparable to that reported in the literature in patients without induction treatment. CMV infection increased the risk of opportunistic infections but not the mortality. Long-term patient and graft survival and graft function were similar in patients with or without CMV. Standard care based upon regular clinical assessment with treatment of symptomatic CMV infection is safe and without deleterious consequences for the patient or the graft in the long term run.