Introduction: Couples with mutual children opting for husband to wife (H2W) kidney donation have a 20-50% chance of husband specific sensitization during pregnancy carrying unpredictable immunological risk. Lack of evidence in this context creates perplexity in H2W donations. 
Aim: To study the characteristics and outcomes in terms of acute rejection, allograft and patient survival of H2W donations in kidney transplant. 
Methods: Single center, retrospective study conducted at IQRAA hospital and research center, Calicut, Kerala, India. Data of recipients who underwent H2W kidney transplants during the period of January 2016 to January 2024 were collected and analysed. Blood group compatible and incompatible transplants were included. Demographic and Immunologic characteristics were analysed, and outcomes studied included incidence of acute rejection, and allgraft and patient survival at 1 year, 3 years and 5 years respectively. 
Results: Out of a total of 890 transplants done during the study period, 23 (2.6%) were H2W donations. Among recipients who received the kidney from their husbands, 7 (30%) were blood group incompatible transplants. The average recipient and donor ages were 44.5 and 52.2 years respectively. The median duration of dialysis was 11 months. Four (17.4%) recipients had diabetes, and twenty (87%) had hypertension pre-transplant. Eight patients (34.8%) had prior exposure to blood transfusion. All (100%) patients had atleast 1 pregnancy event pre-transplant, and 18 (78%) had more than one pregnancy event. Donor specific antibodies (DSAs) were present in 6 patients (26%). Fourteen (61%) patients underwent pretransplant desensitisation with Plasma Exchange +/- Rituximab. Ten (43%) patients received induction therapy with anti-thymocyte globulin (ATG). Seven (30%) patients recevied both pre-transplant desensitisation and induction with ATG. The incidence of acute rejections was 13%. One patient suffered acute T cell mediated rejection, and 2 patients had antibody mediated rejection. One patient developed chronic acitve antibody mediated rejection at 3 years post transplant. None of the patients developed delayed graft function (DGF). There was no allograft loss or patient loss at 1 year, 3 years and 5 years. 
Conclusion: Outcomes in husband-to-wife transplants are comparable to transplants with other donors. Husbands as kidney donors should be considered for living kidney donation with similar risk as that of other donors.