To assess the relationship of donor alanine aminotransferase (ALT) level to recipient hepatitis, 283 transfused patients were prospectively followed up after open heart surgery; hepatitis developed in 12.7%, of which 97% was non-A, non-B. The ALT tests of 3,359 donors to these patients indicated that risk of hepatitis was significantly associated with the level of donor ALT; 29% of 52 patients receiving at least 1 unit of blood with an ALT level greater than 53 IU/L had hepatitis develop (20.7 cases per 1,000 units), compared with 9% of 231 recipients of only blood with an ALT level of 53 IU/L or less (7.8 cases per 1,000 units). Calculation of corrected efficacy predicts that, at an exclusion level equivalent to 2.25 SDs above the mean log for normal subjects, ALT testing of donors could prevent 29% of posttransfusion hepatitis at the loss of 1.6% of donor units.
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