Following liver transplantation, most patients undergo a long process of immunosuppressive therapy. Throughout the patient's entire lifespan, there is a need for immunosuppression, though, at lower doses at later stages, and the interruption of immunosuppressive therapy carries a serious risk of graft rejection.1, 2, 3, 4, 5 Graft rejection is commonly observed due to the patient's non-adherence to immunosuppressive drugs even if these drugs are prescribed by their doctor.

A recent study showed that 21% of liver transplant recipients sometimes forgot to take immunosuppressive drugs and that 33% of them sometimes took them late in the post-transplant period.6 Additionally, drug side effects lowered the rates of adherence to immunosuppressive therapy.7,8 The main reasons for non-adherence include drug side effects, high drug costs, a history of psychiatric disease,9, 10, 11, 12 the long duration of immunosuppressive therapy, complicated drug dosage schemes, and absentmindedness.13 Immunosuppressive drugs can pose challenges for patients to adhere fully to their treatment in the post-transplant stage.

To promote adherence to the constant drug use that is required in chronic diseases and health conditions, the US Centers for Disease Control and Prevention (CDC) develops plans and efforts that aim to overcome patient-level barriers.14 Mindfulness-based interventions are among the methods that are used frequently for the promotion of a patient's therapy adherence. Mindfulness-based interventions include practices aimed at developing the mindfulness of individuals about their thoughts, emotions, and bodily sensations.15 Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy are interventions founded upon the concept of mindfulness. Dialectical Behavior Therapy and Acceptance and Commitment Therapy also involve mindfulness. These interventions have been given prominent importance in the relevant literature.16 It has been reported that all these therapies facilitate the management of patient-related problems that lower therapy adherence rates (anxiety, depression, cognitive problems, and behavioral problems).17, 18, 19, 20

In the relevant literature, it was reported that 30% of liver transplant recipients had anxiety, depression, high levels of worry, and stress21,22 whilst 10% of them experienced post-traumatic stress disorder.23 Severe stress in liver transplant recipients was found to be associated with post-transplant acute rejection, prolonged hospitalization, and an increase in complications.21 Even though mindfulness-based methods have been frequently utilized for the promotion of therapy adherence, they have not been used for the enhancement of adherence to immunosuppressive drugs following liver transplantation. With a randomized controlled design, this study aimed to analyze the effects of Mindfulness-Based Cognitive Therapy (MBCT) on the immunosuppressive therapy adherence levels of recipients following liver transplantation.