*Purpose: Renal transplantation (Rtx) remains the most effective treatment for of end-stage renal disease (ESRD). The development of induction therapy has significantly reduced the incidence of acute rejection within the first six months following kidney transplantation. As a result, induction therapy is typically administered in the majority of kidney transplants. Moreover, early graft function has also improved with the advent and routine administration of induction therapy. Hence we aim to compare short term outcomes between Rtx patient who got induction by either ATG (anti thymocyte globulin) or Grafalon.

*Methods: We enrolled 40 patient who underwent Rtx for ESRD from Jan 2018 to Feb 2019. We gave each patient induction with either ATG (anti-thymoglobulin) (iATG, n=20) dose of 0.5 mg/kg on operation day followed by 1 mg/kg on POD1 and 2 or another group of patient who got induction by Grafalon (iGF, n=20) with a dose of 6-9 mg/ kg in three divided dose. We compared several 1 month post-transplant outcomes in between two groups and 6 month graft and patient survival.

*Results: We compared several post-transplant outcome variables within 1 month such as infectious complication, acute rejection, antibody mediated rejection, delayed graft function, patient and graft survival. We found that biopsy proven acute tubular necrosis (ATN) was significantly higher in Grafalon group (41.67 % vs 0 %, P= 0.009). Similarly the incidence of culture positive infectious complications were also higher in Grafalon group (30 % vs 10 %, P=0.1). Beside this we did not find any difference between other outcomes as well patient and graft survival.

*Conclusions: Although several polyclonal depleting antibodies are commercially available, ATG remains the most commonly utilized therapeutic induction agent with lower incidence of ATN and infectious complication as shown in our study.

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