Transfusion-free kidney transplantation in Jehovah’s witnesses: a propensity-score matched cohort study

Abstract

Background Jehovah’s Witnesses (JWs) refuse blood transfusions on religious grounds, creating a major challenge in kidney transplantation (KT), where perioperative bleeding may necessitate transfusion support. Evidence regarding transfusion-free KT in JWs remains limited. We evaluated the feasibility and early clinical outcomes of a transfusion-free KT protocol in JW patients. Methods We performed a single-centre propensity score–matched cohort study including all JW recipients who underwent KT under a transfusion-free protocol between 2016 and 2025. The protocol included pre-transplant haemoglobin optimisation to ≥13 g/dL. JW recipients were matched 1:3 to non-JW controls based on recipient age and sex, donor type, and transplant date. Outcomes included peri-transplant transfusion, anaemia management, bleeding-related complications, and early post-transplant results. Results 27 JW recipients and 74 controls were included. Peri-transplant transfusion was completely avoided in JW recipients (0/27), whereas 24/74 controls (32.4%) required transfusion support. Bleeding-related complications occurred in 14.8% of JW recipients and 11.3% of controls (RR 1.65, 95% CI 0.44–6.21). Admission haemoglobin was higher in JW recipients (14.2 vs 11.5 g/dL; MD 2.69, 95% CI 2.15–3.22), as was nadir haemoglobin (10.0 vs 8.5 g/dL; MD 1.50, 95% CI 0.55–2.45). However, the absolute decrease from admission to nadir was greater in JW recipients (4.14 vs 3.01 g/dL; MD 1.13, 95% CI 0.21–2.06). Hospital stay was longer in JW recipients (MD 5.2 days, 95% CI −0.10 to 10.31). Conclusions A transfusion-free KT protocol was feasible in JW recipients managed at an experienced centre and enabled complete avoidance of peri-transplant transfusion. Early outcomes are reported descriptively and should be interpreted with caution because of the small sample size and residual imbalance between groups.

The authors' abstract, as published at the source. Frontiers in Nephrology, 2026 · DOI ↗