Rabbit anti-thymocyte globulin is used worldwide to treat and prevent rejection in kidney transplantation. Multiple mechanisms of action of this polyclonal preparation are responsible for its success. Studies have supported clinical benefits of rabbit anti-thymocyte globulin in high immunological risk kidney transplant recipients when used as an induction agent at the time of transplant and for treatment of rejection when compared to other antibody therapy. The evidence of this clinical benefit will be reviewed in addition to examining the dosing and safety profile of rabbit anti-thymocyte globulin.