Introduction: Anti-thymocyte immunoglobulin is the preferred induction agent in kidney transplantation. Anti-thymocyte immunoglobulin derived from rabbit is most commonly used and available in two formulations. Thymoglobulin is produced by immunizing rabbits with human lymphocytes and manufactured by Sanofi. Grafalon is produced by immunizing rabbits with T cell leukaemia line Jurkat and manufactured by Neovii. Though both are rabbit anti thymocye globulin, there are differences in efficacy. In few studies grafalon has been shown to be associated with higher rejection rates. This retrospective comparative analysis is done to determine the efficacy and adverse event of the the two agents.
Study design: 30 patients who underwent living donor kidney transplantation in year 2021-2022 at our institute were included in the analysis. 20 patients received thymoglobulin and 10 patients received grafalon. Maintenance immunosupression included tacrolimus, mycophenolate sodium and steroids in all patients. Patient follow up data for 6 months was analysed.
Analysis: Baseline characteristics were similar in both groups. HLA mismatch were similar in both groups. 1 of 20 (5%) patients in ATG group vs 2 of 10 (20%) in grafalon group developed rejection at end of 6 months (p=0.001).  NODAT developed in 4 (40%) patients in grafalon group as compared to 1(5%) patient in thymoglobulin group (p=0.0001). Infectious complication was more commonly seen in thymoglobulin group in 6 (30%) patients vs  2 (20%) patients in grafalon group (p=0.001). There was no difference in survival and graft loss. 
Conclusion: Grafalon was associated with higher rejection and NODAT risk as compared to thymoglobulin. It was associated with lower risk of infection. These findings are similar to published data. Correlation with NODAT needs to be established in larger cohort.