The long-term evaluation of single bolus high dose antithymocyte globulin (ATG) induction therapy hasn’t been adequately studied. We aimed to evaluate its long-term effects in the living related donor kidney transplantation. Eighty adult recipients with their first kidney allograft were randomized into two equal treatment groups, one group received intraoperative single bolus rabbit ATG in a dose of 9mg/kg and the second group served as a control. All patients maintained on triple immunosuppressive therapy (steroids, calcineurin inhibitor and antiproliferative agent). We followed them thoroughly for minimum of 5 years. ATG significantly reduced the proportion of patients who experienced an acute rejection in the first year (9/40) when compared to the control group (26/40) and in 5 years (11/40) when compared to (30/40) in controls. The cumulative steroid dose used throughout the study was significantly lower in the ATG group. The overall incidence of post-transplant complications was comparable among the two treatment groups. There was no significant difference in patient and graft survival; 5 year patient and graft survival were 100%, 85% for ATG and 95%, 92.5% for control group respectively. Although, routine single bolus ATG induction significantly reduces the incidence of acute rejection; its long-term beneficial effects on graft function and patient and graft survival are not yet evident.