The orbital angular momentum (OAM) of photons is a promising degree of freedom for high-dimensional quantum key distribution (QKD). However, effectively mitigating the adverse effects of atmospheric turbulence is a persistent challenge in OAM QKD systems operating over free-space communication channels. In contrast to previous works focusing on correcting static simulated turbulence, we investigate the performance of OAM QKD in real atmospheric turbulence with real-time adaptive optics (AO) correction. We show that, even our AO system provides a limited correction, it is possible to mitigate the errors induced by weak turbulence and establish a secure channel. The crosstalk induced by turbulence and the performance of AO systems is investigated in two configurations: a lab-scale link with controllable turbulence, and a 340 m long cross-campus link with dynamic atmospheric turbulence. Our experimental results suggest that an advanced AO system with fine beam tracking, reliable beam stabilization, precise wavefront sensing, and accurate wavefront correction is necessary to adequately correct turbulence-induced error. We also propose and demonstrate different solutions to improve the performance of OAM QKD with turbulence, which could enable the possibility of OAM encoding in strong turbulence.