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It is imperative to understand how this applies in the setting of transplantation, where dynamic immune function determines key clinical outcomes, including graft rejection and responses to infection. Sex differences unique to transplant immunity begin at the chromosomal level and are influenced by steroid hormones and sex\u2010specific factors ranging from pre\u2010existing pregnancy\u2010induced alloimmunization to differential metabolism of routine immunosuppressive medications. Given active efforts for greater sex and gender equity in transplantation, and with increasing transplantation of older candidates, the unique immunological considerations at the cross\u2010roads of biological sex and age are also critical to consider. 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Greater efforts to incorporate sex as a biological variable into transplant research will lead to a more tailored strategy for immunosuppressive management, rejection surveillance, infection prophylaxis and other considerations for optimization of transplant outcomes.<\/jats:p>","DOI":"10.1111\/imr.70104","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:20:54Z","timestamp":1769775654000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sex Differences in Alloimmunity and Other Immunological\u00a0Considerations in Organ Transplantation"],"prefix":"10.1111","volume":"338","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7890-227X","authenticated-orcid":false,"given":"Whitney A.","family":"Perry","sequence":"first","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases Tufts Medical Center  Boston Massachusetts 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