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To report on the first 20 ABO blood group incompatible (ABOi) renal transplants performed in New Zealand.Prospective short-term data and retrospective longer-term follow-up data was collected on the first 20 such transplants between March 2008 and April 2015.Patient and graft survival was excellent at 95% at 12 months and final follow-up (11-85 months; median 31 months). Three serious infections were noted in this time period, one of which resulted in patient death (pneumococcal pneumonia). There were no episodes of anti-ABO blood group antibody mediated rejection. Only one patient was not able to achieve appropriate antibody reduction prior to the planned transplant.ABOi transplantation is a safe and successful treatment option for patients with end stage renal failure who cannot access an ABO compatible live donor.