ALSO WITH A RESTRICTIVE TRANSFUSION POLICY, SCREENING WITH 2ND-GENERATION ANTI-HEPATITIS-C VIRUS ENZYME-LINKED-IMMUNOSORBENT-ASSAY WOULD HAVE REDUCED POSTTRANSFUSION HEPATITIS-C AFTER OPEN-HEART-SURGERY

The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) wa s prospectively assessed among open-heart surgery patients from the so utheast region of Sweden before the introduction of anti-hepatitis C v irus (HCV) blood donor screening. Blood samples for alanine aminotrans ferase analysis were drawn before and 2, 3, and 4 months after transfu sion. Surgery was performed in four centres. Of 190 transfused and fol lowed-up patients 2 (1.1%) contracted PTH-NANB, both operated on at th e centre with significantly fewer transfusions than the other centres. One patient had antibodies to HCV detected by first-generation (C100- 3) and later by second-generation anti-HCV enzyme-linked immunosorbent assay (ELISA-2) and by positive second-generation recombinant immunob lot assay (4-RIBA). The other patient, although negative by first-gene ration anti-HCV ELISA, was positive by second-generation ELISA and by 4-RIBA. Both patients were hepatitis C-viremic by polymerase chain rea ction (PCR). All the six donors implicated in the two hepatitis cases were first-generation anti-HCV-negative, but two, one for each patient , were positive by second-generation anti-HCV ELISA. This finding was confirmed by positive 4-RIBA in only 1 donor, the other being 'indeter minate'. However, in both donors hepatitis C viremia was found by PCR. This study shows that the second-generation anti-HCV ELISA will furth er reduce the risk for PTH-NANB/C and draws attention to the problem o f evaluation of confirmatory tests.