Background: Kidney transplantation improves life expectancy in patients with end-stage renal disease but encounters ethical concerns, particularly in commercial transplantation, which yields worse outcomes. Anti-thymocyte globulin (ATG) is an immunosuppressant used as an induction therapy in transplantation. This study evaluates ATG induction therapeutic outcomes in commercial kidney transplants. Methods: A retrospective cohort analysis was conducted on adults who underwent commercial kidney transplantation and were subsequently admitted to King Abdulaziz Medical City spanning 2018 to 2023, with a follow-up period of one year. Results: A total of 70 commercial kidney transplant patients were evaluated by comparing patients who received ATG (n = 24) and those who did not (n = 46). ATG patients had elevated serum creatinine levels at admission (mean 457.5 vs. 172.6 µmol/L, p < 0.001). Over time, creatinine levels in the ATG group improved but remained higher than the non-ATG group (p < 0.001). Despite the higher early rejection rate in the ATG group, this difference was not statistically significant (p-value = 0.256). Elevated admission creatinine strongly predicted rejection (OR = 10.08, p < 0.001). Conclusions: Elevated admission creatinine is a significant predictor of rejection. Although the ATG group showed a higher early rejection rate, this difference was not statistically significant. Early rejection remains a concern, particularly within the first month after transplantation.