Background Patients heterozygous for an abnormal alpha-1 antitrypsin (A1AT) mutation may have an increased risk of liver disease in the setting of a secondary contributing factor. Methods This single-center retrospective cohort study compared donor and recipient outcomes of A1AT heterozygous versus normal phenotype adult living donor liver transplants (LDLTs). Results: Between 2010-2016, 11 A1AT heterozygous donors and 10 recipients were compared to 57 normal donors and 41 recipients. There were no significant differences in sex, age, or race/ethnicity by A1AT phenotype. Heterozygous donors had significantly lower serum A1AT (median 100mg/dL vs 131mg/dL; p
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