OP27 Benefits of paediatric to adult transition program in Inflammatory Bowel Disease: The BUTTERFLY study of GETECCU
Authors: Rubín De Célix C , Martín de Carpi J , Pujol G , Palomino L , Velasco M , Martín-Masot R , Navas-López V M , Ricart E , Casanova M J , Rodríguez Martínez A , Leo E , Alcaraz A , Mañosa M , Hernández V , Fernández R , Sánchez C , Menchén L , Mesonero F , Barreiro-De Acosta M , Martinon N , Tejido Sandoval C , Rendo Vázquez A , Corsino P , Vicente R , Hernández-Camba A , Alberto Alonso J R , Alonso-Abreu I , Castro Millán A M , Peries Reverter L , Castro B , Fernández-Salgado E , Busto Cuiñas M M , Benítez J M , Madero L , Clemente F , Riestra S , Jiménez-Treviño S , Boscá M , Chaparro M , Gisbert J P 
Published: January 2023

Abstract

Background
It has been suggested that the transition of patients from paediatric to adult care units may be key in the outcomes of inflammatory bowel disease (IBD). However, the impact of transition in real clinical practice has been barely studied. Aims: Principal: to evaluate the impact of transition on clinical outcomes in IBD. Secondary: to describe the prevalence of transition programs in Spain; to identify predictive factors of poor clinical outcomes; and to evaluate the percentage of patients with loss to follow-up.

Methods
Multicenter, retrospective, and observational study of IBD patients transferred between 2017-2020. Two groups (transition/no-transition) were compared retrospectively. Transition was defined as a structured process with at least 1 join visit involving the gastroenterologist, paediatrician, and a program coordinator, as well as the parents and the patient. Outcomes within the first 12 months after transfer were analysed. The main variable was the presence of “poor clinical outcome” defined as an IBD flare, hospitalisation, surgery or any change of the treatment due to an IBD flare. Predictive factors of poor clinical outcome were identified in multivariate analysis.

Results
A total of 278 patients from 34 Spanish hospitals were included: 185 patients (67%) from 22 hospitals (65%) performed a structured transition. In hospitals without transition, 91% of the patients were transferred to an IBD-specialist. In 66% of the patients in the transition group, 1 joint visit was performed. The median age of transfer was 16 years [interquartile range (IQR)=12-20]. Baseline characteristics of both groups are detailed in Figure 1.

At 1-year after transfer, hospitalisations and corticosteroid treatment were more frequent in the no-transition group (10 vs. 3%; p=0.025; 16 vs. 5%; p=0.002). At 1-year after transfer, 89 patients (27% transition vs. 43% no-transition; p=0.005) had poor clinical outcome [median time: 9.3 months; 95% confidence interval (CI)=8.4-10.1 in no-transition; 10.4 months (95%CI 9.9-10.9) in the transition group]. In the multivariate analysis, the lack of transition [Hazard Ratio (HR)=2.1; 95%CI=1.4-3.3], IBD activity at transfer (HR=4.9; 95%CI=3.1-7.9), BMI &lt;18.5 (HR=1.9; 95%CI=1.1-3.2) and corticosteroid treatment at transfer (HR=4.8; 95%CI=2.1-10.9) were associated with a poor clinical outcome. Twelve patients (4%) were lost to follow-up [1.1% in the no-transition vs. 5.9% in the transition group (p=0.06)].

Conclusion
In the present study, to our knowledge the largest performed so far, the benefit of paediatric to adult transition program on patients’ outcomes has been demonstrated. The importance of achieving remission before transfer has also been highlighted.