Abstract： Objective To investigate the clinical efficacy and safety of individualized preconditioning to reduce ABO antibodies in ABO-incompatible living donor kidney transplantation.Method A series of six living donor kidney transplants across a range of ABO blood group incompatibilities using individualized preconditioning protocols to reduce ABO antibodies were obtained from September 2014 to July 2015 in West China Hospital,Sichuan University.Preconditioning included tacrolimus,mycophenolate acid and prednisolone with/without the administration of rituximab,plasma exchange or double filtration plasmapheresis.Medical records and electronic databases were reviewed for isoagglutinin titers,patient and graft survival,graft function,rate of rejections,infections as well as for surgical complications.Result Of the six ABOincompatible recepients,there was one female,and five males.ABO blood group incompatibilities were B to O (n =3),AB to B (n =1),AB to A (n =1),and A to O (n =1).After individualized preconditioning,an acceptable isoagglutinin titer (≤1∶8) was obtained on the date of transplantation,and no recepients of isoagglutinin titers rebounded (＞1∶8) within two weeks after transplantation.In total,there was one episode of acute rejection,wound fat liquefaction,acute tubular necrosis,bone marrow suppression and pneumonia in the perioperative period.These complications were well cured after active therapy.No recipients experienced blood coagulation disorders (bleeding tendency/thrombosis) perioperatively.Six recepients were all in excellent physical and mental condition with stale graft fucntion at the recent follow-up.Conclusion Our results indicate that individualized preconditioning protocols to reduce ABO antibodies based on initial titers are technically feasible and lead to excellent short-term survival of ABO-incompatible living donor kidney transplantation.