A success of ABO incompatible transplantation by modern densensitizaion protocol and achieving accommodation is increasing kidney transplantation from living donors up to 30% by surpassing the ABOI barrier. Rituximab has replaced splenectomy, and reports of success with low-dose Rituximab have further reduced the degree of immunosuppression, leading to improved outcomes in terms of infection-associated complications. Plasmapheresis followed by low-dose intravenous immunoglobulin in the USA and India, double filtration plasma separation in Japan, and selective immunoadsorption in Europe have all improved the outcomes of ABOi, with little difference in outcomes. Antithymocyte globulin induction is avoided with the use of Rituximab, and basiliximab is the preferred induction agent, with triple maintenance immunosuppression consisting of tacrolimus, mycophenolate mofetil, and prednisolone. A higher risk of infection and early rejection in a few series have been reported; however, the long-term outcomes remain comparable to ABO compatible transplantation. A multicenter retrospective study from India, comparing 1759 living donor ABOI KT and 33,157 ABOC-KT recipients, showed similar outcomes, with little difference in infection and rejection rates between the groups.