CMV cell-mediated immunity (CMV-CMI) testing has emerged as a promising tool to refine CMV risk stratification and inform prevention strategies in transplant recipients, while recent data assess its role in novel cellular therapies. By identifying patients with robust CMV-specific immune responses, these assays can reduce unnecessary antiviral exposure and support individualized decisions on prophylaxis and preemptive therapy. The strongest evidence comes from the solid organ transplant (SOT) setting, where immune-guided strategies can safely shorten prophylaxis duration, particularly in kidney and lung transplantation. In allogeneic hematopoietic cell transplant (HCT) recipients, CMV-CMI could also guide prophylaxis discontinuation and post-prophylaxis surveillance, although data remain more limited and its added value beyond established clinical markers unclear. In chimeric antigen receptor (CAR)-T-cell therapy recipients, CMV-CMI reaches a nadir at Week 2 post-infusion and recovers by Week 4, defining a window of increased vulnerability during which most CMV reactivation occurs. Assessment at this timepoint may help identify high-risk patients; however, the clinical impact of CMV reactivation, and as a result the need for preventive strategies, remain unclear in this setting. Importantly, the major strength of CMV-CMI lies in its consistently high negative predictive value of robust T-cell responses, while its ability to pinpoint highest-risk patients remains limited. Its widespread use is hindered by assay discordance, limited geographic access, and unproven cost-effectiveness. Despite these limitations, CMV-CMI remains the best-studied strategy for individualized CMV management; further standardization and prospective validation are needed to define its role in increasingly complex immunocompromised populations.

Transplant infectious diseases (ID) has emerged as a distinct area of clinical expertise within the specialty of ID. While formal curricular recommendations for both adult and pediatric TID have been published, there is substantial heterogeneity in how they are operationalized. In this review, we describe a practical framework and tools for building and implementing a TID curriculum and provide concrete guidance for translating high-level recommendations about content and experience into actionable strategies for training programs. This framework draws from curricular components and innovations from four US-based training programs, spanning adult and pediatric TID, and representing both dedicated TID fellowships and TID tracks within general ID training. We highlight components that would be important to any TID educational program, including key personnel, structured didactic offerings, curated external educational resources, experiential learning and professional development opportunities, and assessment tools aligned with TID-specific competencies. We provide concrete examples and adaptable tools, such as didactic schedules and self-directed curricula; guidance for leveraging podcasts, curated medical literature, and other external resources for TID education; as well as strategies to incorporate nonclinical experiential learning opportunities, such as participation in center-specific or professional society meetings, simulation-based donor call training, and protocol development. These frameworks and resources are adaptable to a range of institutional contexts, can supplement the heterogeneity in clinical exposure between programs, and support trainee competence in nonclinical skills unique to TID practice. As the field continues to evolve, scalable curricula will be essential to train the next generation of TID clinicians and educators and ensure high-quality care for an increasingly complex immunocompromised host population.