This bi-lateral lung transplant recipient is a 65 year-old male patient who received his lung transplant due to end-stage lung disease secondary to non-CF bronchiectasis. The donor and recipient CMV serostatus is D+/R+. The patient’s initial peri-operative course was complicated by difficult explant, primary graft dysfunction, respiratory failure requiring prolonged mechanical ventilation, renal insufficiency and recurrent infectious concerns, including pseudomonas and stenotrophomonas pneumonias.