Improving Medication Adherence After Liver Transplantation: Liver Transplantation | August 2026

Introduction:

Long-term adherence to immunosuppression is essential after liver transplantation, yet medication nonadherence remains an important preventable cause of poor graft and patient outcomes. This systematic review and meta-analysis evaluated medication simplification, pharmacist-led care, behavioral interventions, telehealth, and mobile technologies for improving post-transplant adherence.

Why was this study needed?

Lifelong immunosuppression creates substantial treatment burden.

Nonadherence can contribute to rejection, graft dysfunction, and healthcare utilization.

Digital and telehealth interventions are rapidly expanding, but their effectiveness remains uncertain.

The most effective strategies across long-term transplant survivorship needed clarification.

Results:

Across 33 studies, adherence interventions substantially improved medication adherence compared with usual care, although results varied between studies.

Regimen simplification, particularly switching tacrolimus from twice-daily to once-daily dosing, showed the most consistent benefit while maintaining acceptable graft outcomes.

Pharmacist-led and multidisciplinary programs improved medication knowledge, dosing compliance, and therapeutic drug monitoring.

Telehealth reduced travel burden and, in some studies, hospital readmissions and length of stay; evidence for mobile/text-based interventions was more variable.

Clinical Impact:

The most effective strategy may not be sophisticated technology but making treatment simpler and providing structured multidisciplinary support. Telehealth can complement this approach by reducing access barriers and enabling closer monitoring, particularly for patients living far from transplant centers.

Bottom Line:

Medication adherence after liver transplantation improves most consistently through simplified immunosuppression—especially once-daily tacrolimus—combined with pharmacist and multidisciplinary support. Telehealth is a valuable facilitator, but technology should complement rather than replace structured transplant care.