Alpha-1 Antitrypsin Deficiency Adult Liver Study

Liver Biopsy Group: Inclusion Criteria * Adults (≥ 18 years of age), with Alpha-1 Antitrypsin Deficiency * Documented evidence Pi-ZZ phenotype or genotype * Both genders, all races and ethnic groups * Willingness to be followed for up to 5 years Exclusion Criteria: * Evidence of advanced liver disease defined by Child-Pugh Class B or C (score ≥ 7) * Known advanced lung disease defined as forced expiratory volume at one second (FEV1) \< 40 % of Predicted * History of Organ Transplantation * Known congenital or metabolic liver disease (e.g.: Wilson's, glycogen storage, cystic fibrosis)or iron overload as evidenced by ≥ Grade 3 iron staining on a previous liver biopsy * Evidence of chronic hepatitis B (marked by the presence of HBsAg in serum) or Hepatitis C (marked by the presence of anti-hepatitis C virus (HCV) or HCV RNA in serum) * Vascular disorders of the liver (e.g.: cardiac sclerosis, acute or chronic Budd-Chiari, hepatoportal sclerosis, peliosis) * Known HIV positivity * Diagnosis of malignancy within the last 5 years * Active substance abuse, that in the opinion of the study investigator, would interfere with adherence to study requirements * Concomitant severe underlying systemic illness or medical condition which in the opinion of the investigator, would make the patient unsuitable for the study or would interfere with completion of follow-up * Inability to comply with the longitudinal follow-up as outlined in the protocol * Failure of the participant to sign inf…