ABO-incompatible living donor liver transplant (ABOi LDLT) is helpful in increasing the donor pool, especially in the countries that predominantly perform living donor liver transplants. With improvements in desensitization protocols and immunosuppression regimes, outcomes of ABO incompatible and compatible liver transplants are comparable. Risk of allograft rejection, biliary complications, and infectious complications are the main reasons for graft dysfunction and mortality in ABOi LDLT recipients. Rituximab and plasmapheresis are the main methods of pretransplant desensitization to decrease the risk of allograft rejection. Postoperative immunosuppression consists mainly of three drugs: tacrolimus, mycophenolate mofetil, and corticosteroids. Post-transplant monitoring of ABO antibody titer should be done for the first 2–4 weeks. Graft rejection is managed by plasmapheresis, steroid pulse, and adjusting the dose of tacrolimus and mycophenolate. Intravenous immunoglobulins and anti-thymocyte globulin are used in steroid refractory rejection. Newer drugs like proteasome inhibitors and complement inhibitors have shown promising results in the management of AMR.