Costanzo D, Bindi M, Ghinolfi D, et al. - Since Jehovah’s Witnesses deny blood transfusion on religious grounds and liver transplantation is historically related to potential massive perioperative blood loss, therefore, Jehovah’s Witnesses represent a great clinical challenge when indicated to this procedure, and keeping this in mind, researchers undertook this retrospective review to define a perioperative management pathway with strategies toward a transfusion-free environment, to ultimately afford not only liver transplant to selected Jehovah’s Witnesses patients but also to translate this practice to all general surgical procedures. They analyzed data for Jehovah’s Witnesses patients who had liver transplantation at their Institution. A preoperative red cell mass optimization package and the intraoperative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure were included in the perioperative multimodal strategy to liver transplantation in Jehovah’s Witnesses. Among 13 Jehovah’s Witness patients who underwent liver transplantation, 4 developed acute kidney injury (one needed extracorporeal renal replacement therapy) and one required vasoactive medications to support blood pressure for the first 2 postoperative days. Re-laparotomy was performed on 2 patients. One-year follow-up revealed 12 alive recipients and the death of one because of septic complications. Experts concluded that liver transplantation, when performed at a very experienced centre and using a multidisciplinary approach, can be feasible and safe in selected Jehovah’s Witnesses patients, as confirmed by the findings.