Objective: Retrospective study (January 2012 to June 2019).164 patients were included in the study. Biochemical parameters, serial IgG Anti-ABO titres and class I and II DSA findings recorded. Graft biopsies were reviewed in detail according to the Banff 2017 update.  Methods: 65 biopsies from 54 patients were reexamined. Acute antibody mediated rejection (12.8%) was more than acute cellular rejection (1.8%). AMR cases had evidence of microvascular inflammation (g+ptc≥2) and C4d positivity in 100% cases. Acute tubular injury (ATN) alone was seen in 10.3 % patients. 65% of these patients had C4d positivity in peritubular capillaries(mild to moderate) and only one case developed chronic active antibody mediated rejection on follow up. 1 year patient and death censored graft survival after transplantation was 92% and 98% respectively and at 3 year it was 88% and 91%. Patients with AMR had reduced patient (76.5%) and death censored graft survival (84.6%) at 1 year. Results: AMR can be reliably diagnosed in ABO-i transplants by looking at microvascular inflammation (g+ptc≥2) score. Acute tubular injury with C4d positivity without microvascular injury does not confirm AMR.  We recommend specific diagnostic criteria for ABO-incompatible transplants in Banff classification. Conclusions: Objective: ABO-i renal transplantation has gained momentum and over the last decade it has helped to expand the donor pool.Many studies describing protocol biopsies in ABO-i transplant patients have been published in literature. Present study describes renal biopsy findings in  indication renal biopsies performed for graft dysfunction. Methods: Retrospective study (January 2012 to June 2019).164 patients were included in the study. Biochemical parameters, serial IgG Anti-ABO titres and class I and II DSA findings recorded. Graft biopsies were reviewed in detail according to the Banff 2017 update.  Results: 65 biopsies from 54 patients were reexamined. Acute antibody mediated rejection (12.8%) was more than acute cellular rejection (1.8%). AMR cases had evidence of microvascular inflammation (g+ptc≥2) and C4d positivity in 100% cases. Acute tubular injury (ATN) alone was seen in 10.3 % patients. 65% of these patients had C4d positivity in peritubular capillaries(mild to moderate) and only one case developed chronic active antibody mediated rejection on follow up. 1 year patient and death censored graft survival after transplantation was 92% and 98% respectively and at 3 year it was 88% and 91%. Patients with AMR had reduced patient (76.5%) and death censored graft survival (84.6%) at 1 year. Conclusions: AMR can be reliably diagnosed in ABO-i transplants by looking at microvascular inflammation (g+ptc≥2) score. Acute tubular injury with C4d positivity without microvascular injury does not confirm AMR.  We recommend specific diagnostic criteria for ABO-incompatible transplants in Banff classification.