Objectives: ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) is one of efforts to overcome organ shortage for end stage kidney disease(ESKD) patients. There were many studies about the comparison of ABOi and ABO-compatible (ABOc) LDKT outcomes until now. Because these data are useful for only patients who have a compatible donor, the clinically practical question is whether to proceed with ABOi LDKT or remain on dialysis while waiting for ABOc deceased donor kidney transplantation (DDKT). To study this further, we compared outcomes of ABOi LDKT and those who wait for ABOc DDKT. Methods: Four hundred twenty four patients underwent ABOi LDKT between 2010 and 2020 in Seoul National University Hospital and Severance Hospital. We compared outcomes between ABOi LDKT group and the matched control groups (ABOc-LDKT group, n=426; waiting-list-only group, n=1278; waiting-list-or-ABOc-DDKT group, n=1278). The matched controls were derived from 3053 adult waiting lists for first-time kidney transplantation alone, 416 ABOc DDKT and 1366 ABOc LDKT patients. Results: Patient survival rates of the ABOi-LDKT group were significantly lower than those of the ABOc-LDKT group at 1 year (97.9% vs. 99.8%, respectively) and 8 years (95.2% vs. 97.2%), respectively (P=0.032). Furthermore, ABOi-LDKT group showed significantly lower death-censored graft survival rate compared to ABOc-LDKT group (P=0.032). Next, we compared outcomes of ABOi-LDKT compared to those of waiting-list-only group and waiting-list-or-ABOc-DDKT group. Patient survival rates at 1- and 8-years in the waiting-list-only group were 97.8%, and 89.1%, respectively, and those in the waiting-list-or-ABOc-DDKT group were 97.7% and 89.3%, respectively. ABOi-LDKT group showed significantly better patient survival rate compared to waiting-list-only group (P=0.015) and waiting-list-or-ABOc-DDKT group (P=0.018). Therefore, ABOi LDKT has better outcomes compared to dialysis waiting for ABOc DDKT, although ABOi LDKT has worse outcomes compared to ABOc LDKT.  Conclusions: In conclusion, ABOi LDKT is a better choice for ESKD patients without potential ABOc living donors.