Sex and Gender Bias in Kidney Transplantation: 3D Bioprinting as a Challenge to Personalized Medicine

In this article, we explore to what extent sex and gender differences may be reproduced in the 3D bioprinting of kidneys. Sex and gender differences have been observed in kidney function, anatomy, and physiology, and play a role in kidney donation and transplantation through differences in kidney size (sex aspect) and altruism (gender aspect). As a form of personalized medicine, 3D bioprinting might be expected to eliminate sex and gender bias. On the basis of an analysis of recent literature, we conclude that personalized techniques such as 3D bioprinting of kidneys alone do not mean that sex and gender bias does not happen. Therefore, sex and gender considerations should be included into every step of developing and using 3D-bioprinted kidneys: in the choice of design, cells, biomaterials, and X-chromosome-activated cells.