Cytomegalovirus (CMV) infection is a frequent complication early post-transplant. This study examines its impact on chronic allograft changes, long-term graft loss and patient survival. We studied 594 patients who had protocol biopsies at 6 weeks, 3 and 6 months post-transplant. Chronic allograft changes were evaluated according to the updated Banff classification (IF/TA (interstitial fibrosis/tubular atrophy), vascular and glomerular lesions). Follow up data was available up to 10 years. CMV infection was diagnosed in 153 of 594 patients (26%) in the first year after transplantation, mostly within the first 3 months. Graft survival was reduced in patients with CMV (p=0.03) as well as the combined allograft/patient survival (p=0.008). Prevalence of IF/TA at 6 weeks after transplantation was already 3-fold higher in patients who experienced CMV infection later-on, compared to patients without CMV (p=0.005). In multivariate analyses CMV viremia or disease were not a significant factor for graft loss or death. In conclusion, patients with CMV infection post-transplant show more chronic allograft changes early-on –even before CMV infection– and development of IF/TA is not more prevalent in patients with CMV. Our data do not support a significant role of CMV in patient and graft outcomes.