This year commemorates the 100th anniversary of the discovery of the ABO blood group system by Karl Landsteiner. His findings of red cell agglutination by serum and recognition of blood groups laid the scientific basis for safe practice of blood transfusion. Even though dozens of blood systems have been identified, the ABO system still remains to be one of the most important systems in transfusion medicine. In 1990, we elucidated the molecular genetic basis of three major alleles at the ABO locus. Since then we have witnessed the progress in our understanding of ABO genes and A and B glycosyltransferases specified by a variety of functional alleles at this locus. Mutations affecting the activity and specificity of the enzymes have been identified. Not only has ABO genotyping become possible, but it has also become possible to genetically engineer the activity and specificity of the enzymes. We are now at a point of embarking upon the quest of understanding the functional significance of ABO polymorphism.