Effect of Digital Follow-up Supported Patient Education on Immunosuppressive Medication Adherence and Quality of Life After Liver Transplantation

Lifelong adherence to immunosuppressive medication is essential for preventing graft rejection and maintaining long-term graft survival after liver transplantation. However, medication non-adherence remains a common problem and may negatively affect patient outcomes and quality of life. Digital follow-up interventions may improve adherence by providing regular reminders and educational support after discharge.

This single-blind randomized controlled trial was conducted at the Liver Transplant Center of Acibadem Kent Hospital, İzmir, Türkiye. Adult liver transplant recipients who met the eligibility criteria were randomly assigned to either a digital education group or a control group. All participants received standard discharge education. In addition, participants in the intervention group received structured digital follow-up messages for 12 weeks. The control group received routine follow-up care only.

The primary outcome was immunosuppressive medication adherence, assessed using the Immunosuppressive Medication Adherence Scale (MMAS-8). The secondary outcome was quality of life, assessed using the Chronic Liver Disease Questionnaire (CLDQ 2.0). Outcomes were evaluated before the intervention and at the end of the 12-week follow-up period.

Inclusion criteria

• Age 18 years or older.
• Having undergone liver transplantation.
• Currently receiving immunosuppressive therapy after liver transplantation.
• Ability to read and write in Turkish.
• Ability to use a smartphone to receive and follow digital messages.
• Willingness to participate voluntarily in the study.
• Provision of written informed consent.

Exclusion criteria

• Experiencing an acute rejection episode during the study period.
• Presence of cognitive, psychiatric, or communication problems that would interfere with participation in the study.
• Inability to regularly follow digital messages.
• Difficulty reading and understanding Turkish.
• Inability to maintain communication throughout the study period.
• Refusal to participate in the study.