Objectives: To estimate the remaining risk of HCV transmission from recently infected blood donors and to determine the association of elevated ALT levels and confidential self-exclusion with the marker anti-HCV. Blood Donors and Methods: Between June 22, 1994, and November 11, 1995, 130,476 blood donors donated 294,927 units of whole blood in the Institute Breitscheid of the German Red Cross Blood Transfusion Service of North Rhine-Westphalia; 23,281 were first-time donors. ALT testing was done with an Olympus AU 560 analyzer at 37 °C. Results were corrected with a lot-specific factor to obtain international units that would be measured at 25 °C. Results:0.32% of first-time donors were repeatably reactive (rr) in the Ortho III anti-HCV enzyme immunoassay (EIA), however only 0.10% were also positive in the RIBA-2. Surprisingly, as many as 0.11% of repeat donors were also EIA-rr and 0.02 (n = 24) were RIBA-positive, but in only two a seroconversion could be demonstrated. EIA-rr results could frequently be confirmed by RIBA when the serum ALT was elevated. If the level of ALT was normal, confirmation was rare. Among the 585 donors who had chosen confidential self-exclusion, neither in the index donation nor in a subsequent donation (n = 374) specific markers for HCV or HIV were found. No seroconversion for HBsAg was observed. Donors who had chosen confidential self exclusion were much more likely to choose confidential self-exclusion on subsequent donations as well. Conclusions: The remaining risk of HCV infection from a recently infected donor is, in our donor population, less than 1 in 100,000 donations. It is likely to be further reduced by ALT testing. A benefit of confidential self-exclusion could not be demonstrated.

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