{'fraction_non_alphanumeric': 0.02140134857812958, 'fraction_numerical': 0.011433597185576077, 'mean_word_length': 5.486692015209125, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Region‐specific challenges for minimizing endemic donor‐transmitted infections

In both the developed and developing worlds, there are 150 to 200 patients who develop end-stage organ failure and require transplantation for every million persons, but the rate of transplant activity has been estimated to be less than 10 transplants per million persons in the developing world and 40 to 50 transplants per million persons in the developed world. Living donors provide 44% of the organs in developed countries and 85% to 100% of the organs in developing countries, and this may provide opportunities for better screening. The incidence of donor-transmitted infections (DTIs) in developed countries has been estimated to be less than 1%. Similar DTI estimates for developing countries are not known. Several organisms, including many bacteria, fungi, mycobacteria, parasites, and viruses, have been reported to be transmitted from transplant donors to recipients. DTIs that are endemic to certain parts of the world may be considered exotic when they sporadically occur in nonendemic areas; this does not apply when these infections occur in endemic areas. Transplant recipients can acquire infections endemic to their communities in 3 ways: (1) graft transmission, (2) reactivation of a latent infection due to immunosuppression, and (3) de novo exposure. Measures to prevent reactivation and de novo exposure are well described in the literature. Measures to prevent graft transmission deserve more attention. The prevalence of endemic infections in a certain geographic location determines the extent to which basing the selection of donors on the identification of these infections is realistic. In this issue of Liver Transplantation, Vincenzi et al., who previously reported their extensive experience with left lateral segmentectomy for pediatric living donor liver transplantation, describe a retrospective case series of patients with schistosomiasis transmitted through infected liver allografts; this is the largest such series published to date. Schistosomiasis is the second most prevalent tropical disease affecting humans; worldwide, 700 million people are estimated to be at risk of infection. It is somewhat surprising that even though schistosomiasis is endemic to the northeastern region of Brazil, the authors identified only 6 cases among 678 consecutive liver transplants over 19 years (ie, 0.9% of donors). This may be explained by the fact that perioperative liver biopsy was performed only for select living donors when an ischemic liver segment was identified. Donors were screened by fecal analysis, liver ultrasonography, and liver chemistry tests. These measures are not sensitive enough to detect silent schistosomiasis. Thus, this rate of 0.9% is likely an underestimation of the true incidence of donortransmitted schistosomiasis in that region. The authors clearly outline their rationale for not treating Schistosoma mansoni–infected liver allograft recipients for this infection. The outcomes for similar, previously published cases and the 5 living donor cases in this series were favorable, although the 4 previously reported Schistosoma-infected liver allograft recipients were treated with praziquantel. However, it is noteworthy that Vincenzi et al. describe a case of early allograft loss involving a deceased donor who was determined to be Schistosoma-infected only at the