*Purpose: Efficacy of several CMV anti-viral strategies has been shown in controlled trials for CMV infection/disease in kidney transplant recipients (KTRs). However, a comprehensive analysis of observational data published on the real-world burden of CMV infection/disease in the current era are lacking. Therefore, we conducted a systematic literature review to examine epidemiology of CMV infection/disease among kidney transplant recipients (KTRs) in more recent observational studies.

*Methods: MEDLINE and Embase were searched to identify observational studies published from January 2008 to November 2018 reporting incidence of CMV infection/disease among adults undergoing kidney transplant. Studies with no reporting on underlying population CMV serostatus, sample size <50 , ABO-incompatible KTRs were excluded. Meta-analysis was used to derive pooled incidence rate with 95% confidence intervals(CIs) using the random-effects models and I² statistics to estimate heterogeneity between studies using R version 3.5.1.

*Results: Of 1,860 retrieved citations, 62 studies with a total of 19,910 KTRs met inclusion criteria. The majority of studies were single-center(N=37)/multicenter(N=6) retrospective cohort studies (N=43) and conducted in Europe (N=40 studies). Valganciclovir (for prophylaxis-PROPH)/Ganciclovir (for preemptive-PET) were most commonly utilized agent with different dosage/duration across the studies. Among high risk CMV KRTs, both pooled incidence rates for early [PROPH: 2-13%; PET: 38-56%; Deferred: 55%; Hybrid: 43%] and late CMV infection [PROPH: 19-50%; Hybrid: 7-28%] or any CMV infection [PROPH: 8-47% and PET: 42%] varied widely by CMV preventive approaches (see Figure 1). Pooled early [Hybrid: 6-13%] or late CMV disease [PROPH: 2-14%; PET: 4%; Hybrid: 7%] or overall CMV disease [PROPH: 2-10%; PET: 0-10%; rates also varied by different CMV preventive approaches. Similar trends were noted for both CMV infection/disease for intermediate risk CMV KTRs.

*Conclusions: Our findings highlight that CMV infection/diseased occurred frequently even with similar preventive approaches. Wide variations in the incidence of CMV across studies could be due to differences in the underlying CMV definitions and time points of assessment suggesting the needs for standardizing CMV detection to appropriately quantify burden of CMV across the globe.

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