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Serious organ shortages have necessitated the use of ABO-incompatible (ABOi) kidneys transplantation, which has been increasingly preformed in Korea. However there are few detailed long-term comparative data regarding patient and graft survival, graft function, and complications in Korean patients receiving ABO-compatible (ABOc) and ABOi kidney transplants (KT).This retrospective study compared 35 consecutive ABOi living donor KTs with 138 ABOc living donor KTs using same maintaining immunosuppressive regimens and all patents were followed up more than 5-year. We examined preoperative demographic factors, immunologic risk factors, and patient & graft survivals until 5 years after transplantation, postoperative renal function, acute rejection episodes, infections, medical and surgical complications, duration of hospital stay as well as cause for readmission, and their rates by 2 years after transplantation.Patient survival was similar between the ABOc and ABOi group (97.8% vs 94.2% at 1 year, 97.1% vs 94.3% at 3 years, and 97.1% vs 94.2% at 5 years; P=.108). Graft survival also comparable between ABOc group (96.4%, 94.8%, and 94.2% at 1, 3, and 5 years) and ABOi group (91.4%, 91.4% and 91.4% at 1,3, and 5 years; P=.334). There were no significant differences in terms of and graft function until 2 years after transplantation. Acute antibody mediated rejection episodes, bleeding complications, BK virus infections, and preoperative hospital stay were significantly greater in the ABOi group by 2 years after transplatation (P = .001, P = .002, P = .005, and P < .001 respectively).We concluded that, despite some disadvantages, ABOi KT is a viable, safe option for patients whose only available donor is blood group incompatible.