The frequency of SERPINA1 MZ genotype did not differ when comparing the pooled subgroups VIR, AIH-CHOL and MET with controls (24 of 798; 3.0% vs 89 of 3483, 2.6%; N.S.)The SERPINA1 MZ genotype carriage increased the risk of liver cirrhosis only in patients with ALD (OR 2.63; 95% CI 1.78–3.89) and MASLD (OR 4.74; 95% CI 2.92–7.70), p < 0.0001 for both groups. Here, SERPINA1 is linked to autoimmune hepatitis.