Safety Trial of Single Versus Multiple Dose Thymoglobulin Induction in Kidney Transplantation

Inclusion Criteria: * Subject capable of giving written informed consent, with end-stage kidney disease, who is a suitable candidate for primary kidney transplantation * Male or female subject who has reached legal age in the state where they reside and is at least 18 years of age * Deceased or living donors * Compatible ABO blood type * Expanded-criteria donor (ECD) kidneys with a donor grade score of ≤ 25 (as developed by Nyberg, et al.) * If Kidneys are pumped, they must meet the following pumping parameters: resistance \<0.35 with a flow rate of \>60 ml/min. Exclusion Criteria: * Recipient age \>65 years * PRA \>50%, or donor-specific antibody * CIT \>30 hours * Re-transplant patients * Multi-organ transplant recipients (example: kidney/pancreas or kidney/liver) * Renal transplant recipients planned for future pancreas transplantation * Current unstable cardiovascular disease or history of myocardial infarction within the previous 6 months * Current malignancy or history or malignancy (within the previous 5 years) with the exception of non-metastatic basal or squamous cell carcinoma of the skin or carcinoma in-situ of the cervix that has been treated successfully. * Hepatitis B and C recipients or active liver disease * HIV positive recipients * Primary disease requiring treatment with steroids after transplantation * Expanded-criteria donor kidneys (current UNOS criteria) with a donor grade score of \> 25 * Donation after cardiac death (DCD) donors * Dual adult kidneys * Recipients of pediatric (age \<12 years) unilateral or en-bloc kidneys * Previous treatment with rATG * Known hypersensitivity, extensive exposure, or allergy to rabbits * Pregnant * Any condition that in the investigator's opinion may compromise study participation (e.g., history or likelihood of non-compliance with immunosuppression regimen, protocol visits, tests, and studies) Relative Exclusion Criteria: * Patients with a BMI \> 37 should be considered on an individual basis based on overall health and body habitus.