ABO incompatibility is present in 20 to 30% of living donor/recipient pairs, and with the increasing success of ABOi programs, ABO incompatible renal transplantation is now established as a vital component in living donor kidney transplantation. This talk will review progress in the field, present data on protocols that maximise safety and success, examine optimal use of ABOi to overcome the more challenging immunological barrier of HLA incompatibility,  and explore extension to transplantation of deceased donor kidneys and other solid organs.