To analyze the effect and impact of low-dose rituximab induction therapy on cytomegalovirus infection in living-donor renal transplantation. A total of 92 recipients undergoing living-donor renal transplantation at Okayama University Hospital from May 2009 to August 2018 were evaluated retrospectively. Indications for preoperative rituximab (200mg/body) were the following: (i) ABO major mismatch; (ii) ABO minor mismatch; (iii) donor-specific anti-human leukocyte antigen antibody-positive; and (iv) focal segmental glomerulosclerosis. We excluded four recipients who were followed <3months, five who received >200mg/body rituximab and seven who received prophylactic therapy for cytomegalovirus. There were 59 patients in the rituximab group and 17 in the non-rituximab group. Groups differed significantly in age (median age 53 vs 37years, respectively; P=0.04), but not in sex (male 64% vs 65%, P=1.00), focal segmental glomerulosclerosis (3% vs 0%, P=1.00) or percentage of cytomegalovirus-seronegative recipients of renal allografts from cytomegalovirus-seropositive donors (12% vs 18%, P=0.68). The estimated glomerular filtration rate did not differ significantly between groups until 24months after transplantation. Cytomegalovirus clinical symptoms (10% vs 24%, P=0.22), including fever ≥38°C (5% vs 12%, P=0.31) and gastrointestinal symptoms (5% vs 12%, P=0.31), and the 5-year survival rates of death-censored graft loss (90% vs 83%, P=0.43) did not differ significantly between groups. Low-dose rituximab induction therapy is effective in immunological high-risk recipients without increasing cytomegalovirus infection in the absence of valganciclovir prophylaxis.