Which statement about Alpha-1 antitrypsin deficiency and liver disease is most accurate?

• A. Hepatocellular carcinoma only
• B. Cirrhosis only
• C. Neither hepatocellular carcinoma nor cirrhosis
• D. Hepatocellular carcinoma and cirrhosis

Answer: (D)

Alpha-1 antitrypsin deficiency can cause liver disease through the buildup of misfolded AAT protein inside hepatocytes. This accumulation triggers cellular injury, inflammation, and progressive fibrosis, eventually leading to cirrhosis. Over time, the chronic injury and ongoing hepatocyte turnover create an environment that increases the risk of hepatocellular carcinoma. Because both cirrhosis and HCC can arise from AAT deficiency, the statement that includes both conditions is the most accurate. The idea that only one occurs or that neither occurs doesn’t fit the observed spectrum of liver disease in this condition.