Background:In view of ever-increasing end-stage renal disease (ESRD) population but inadequate availability of suitable donors, ABO-incompatible (ABOi) transplantation can be an important void filler. The initial enthusiasm has been slightly lessened in view of higher rate of infections and poor graft survival as compared ABO-compatible transplant. This study was conducted to study the outcomes of ABOi that were performed over the last decade. Methods: Data from 2012 to 2021 was retrospectively analyzed of all the ABOi transplant performed in a tertiary care hospital. The anti-ABO antibody (IgG) titers (1:4) were considered safe before transplantation. Desensitization included Rituximab, Plasma exchange or selective immunoadsorption column. Tacrolimus and mycophenolate mofetil were initiated at day 7. Induction agent included ATG, ATLG, Basiliximab or no induction. Postoperatively, Anti ABO titers were done daily for 2 weeks. Results: A total of 202 patient underwent transplantation, 195 patients whose data for available for 12 months, were included in the study. UTI was the most common source of infection, occurring in almost half (46.1%) of the patients. ABMR (15%) was common in the first year. Death censored patient survival was 86.6% (169/195) at 1 year. Sepsis was the most common of death in more than two-thirds of the population including COVID-19 associated mortality in nine (4.6%) patients. Graft survival was 89.3% (174/195). AMR was the leading cause of graft loss in almost half of the patients. Conclusions: ABOi should be considered in ESRD patients where suitable ABO compatible donor is not available. Higher rate of rejection and, infection are still a major concern.

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