Introduction: ABO-incompatible kidney transplantation (ABOi-KT) is now increasingly performed in adults and children to expand the living-donor pool and address organ shortages.
Case presentation: We report the case of a 6-month-old girl with end-stage renal disease due to congenital renal anomalies who underwent living-donor ABOi kidney transplantation from her grandmother. Pretransplant antibody titers were low, and the procedure was carried out without any preconditioning treatment. Postoperative management included immunosuppression and supportive therapies, with gradual recovery of graft function. The patient was discharged with excellent renal function and remains clinically stable on postoperative Day 120.
Conclusion: This case illustrates the unique "window of opportunity" in early infancy, when low isohemagglutinin levels allow successful ABOi transplantation without the need for extensive desensitization. It further emphasizes that, in the setting of organ shortage, ABOi kidney transplantation can be a safe and effective option for carefully selected pediatric patients and even in infants.
Keywords: ABO incompatibility; end stage renal disease; infant; kidney transplantation.
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