After diagnosis, patients should first be assessed for liver and pulmonary function.13 14 Sandhaus et al recommend individuals with AAT deficiency to be monitored for liver disease at annual intervals (or more frequently as indicated by clinical circumstances), with physical examination including a focused examination for signs of liver disease, laboratory monitoring and liver ultrasound.13 Guidelines call for regular screening that includes ultrasound examination of the liver, in AAT patients with cirrhosis, every 6 months.14 The gene discussed is SERPINA1; the disease is alpha 1-antitrypsin deficiency.