Patients with AP often develop prediabetes and/or DM after discharge from hospital, and have a greater than twofold increased risk of DM over 5 years. Further studies are warranted to determine the optimal strategy for its detection and whether the risk of developing DM after AP can be reduced.

Available evidence showed increased risk of poor graft outcome in moderate-severe steatotic livers. A large prospective multi-centred trial will be required to identify the true risks of steatotic livers. Consistent definition of primary non-function/impaired primary function and description of type of steatosis is also required.

Aims/hypothesis Cu(II)-selective chelation with trientine ameliorates cardiovascular and renal disease in a model of diabetes in rats. Here, we tested the hypothesis that Cu(II)-selective chelation might improve left ventricular hypertrophy (LVH) in type 2 diabetic patients. Methods We performed a 12 month randomised placebocontrolled study of the effects of treatment with the Cu (II)-selective chelator trientine (triethylenetetramine dihydrochloride, 600 mg given orally twice daily) on LVH in diabetic patients (n=15/group at baseline) in an outpatient setting wherein participants, caregivers and those assessing outcomes were blinded to group assignment. Using MRI, we measured left ventricular variables at baseline, and at months 6 and 12. The change from baseline in left ventricular mass indexed to body surface area (LVM bsa ) was the primary endpoint variable.Results Diabetic patients had LVH with preserved ejection fraction at baseline. Trientine treatment decreased LVM bsa by 5.0± 7.2 g/m 2 (mean ±SD) at month 6 (when 14 trientine-treated and 14 placebo-treated participants were analysed; p=0.0056 compared with placebo) and by 10.6± 7.6 g/m 2 at month 12 (when nine trientine-treated and 13 placebo-treated participants were analysed; p=0.0088), whereas LVM bsa was unchanged by placebo treatment. In a multiple-regression model that explained~75% of variation (R 2 =0.748, p=0.001), cumulative urinary Cu excretion over 12 months was positively associated with trientine-evoked decreases in LVM bsa . Conclusions/interpretation Cu(II)-selective chelation merits further exploration as a potential pharmacotherapy for diabetic heart disease.