*Purpose: Transplant in Jehovah’s Witnesses (JW) has been controversial due to their religious beliefs resulting in frequent refusal to accept a wide range of blood products leading to concern for the patient’s safety and favorable outcomes. Even today, some kidney transplant (Ktx) programs will not approve JW candidates who will not accept blood products. Prior to the use of erythropoiesis-stimulating agents (ESAs), JW patients in particular went to Ktx with lower hemoglobin (Hg) levels making the need for life saving transfusions more likely. Now in the age of ESAs, JW patients can proceed to Ktx with higher Hg levels making the surgery itself safer. We studied Ktx outcomes in JW patients before and after the use of ESAs.

*Methods: JW Ktx recipients between 1984 and 2019 were matched (3:1) with controls having similar characteristics (age, gender, ethnicity, hypertension, diabetes, and donor source) and outcomes studied (patient survival, death-censored graft survival, and rejection rates). The group was divided into a pre-ESAs era (1984-1992; JW n=13) and ESAs era (1993-2019; JW n=24). Data were analysed using Kaplan Meier survival curves.

*Results: In the pre-ESAs group, death censored graft survival was significantly lower in JW patients (p=0.004) but there was a trend to higher mortality (p=0.107) and increased rejection rates (p=0.149). In contrast, in the ESAs era there were no differences between the groups in mortality, death censored graft survival, and rejection rates.

*Conclusions: Although the numbers are small, our single-center data suggest that in the current ESAs era, Ktx outcomes are similar between JW patients and matched controls.

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