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    Effect of Acceptance and Commitment Therapy on Motivation and Adherence to Immunosuppressive Medication in Liver Transplant Recipients: A Randomized Controlled Trial
    (Wiley, 2025) Saritas, Serdar; Okutan, Serafettin; Saritas, Hasan; Bulbuloglu, Semra
    Background: After liver transplantation, recipients continue to receive immunosuppressive drug regimens at varying doses for years to ensure graft function and survival. Although liver transplant recipients are aware of the importance of immunosuppressive drug regimens, treatment compliance may decrease over time due to low motivation, putting recipients at risk of organ rejection. Acceptance and commitment therapy (ACT) appears to be an ideal solution for increasing motivation and, indirectly, treatment compliance. Objective: The aim of this study was to investigate the effect of ACT on adherence to immunosuppressive medication and motivation in liver transplant recipients. Methods: This study was conducted at an organ transplant hospital with the participation of recipients who had completed at least 6 months post-liver transplant. The sample included n = 140 liver transplant recipients (n = 70 experimental, n = 70 control). The study was randomized and controlled. The control group received no intervention, while the experimental group underwent an eight-session ACT program administered by a psychologist. Data collection utilized a personal characteristics form, the Adherence to Immunosuppressive Drug Regimen Scale (AIDRS), the Mindfulness Scale (MS), and the Adult Motivation Scale (AMS). Data analysis was performed using descriptive statistical methods and tests of significance for differences between variables. Findings: According to the homogeneity tests of this study, there was no statistically significant difference between the control and experimental groups in terms of individual characteristics (age, time since transplantation, immunosuppressive drugs, comorbidities, etc.). In the experimental group, the level of adherence to the immunosuppressive drug regimen after ACT was very close to the maximum AIDRS score. In the control group, the level of compliance with the immunosuppressive drug regimen was close to the mean value of the AIDRS. The differences mentioned in both groups were statistically significant (p < 0.05). In addition, the scores obtained from the MS and YMS were higher than those in the pretest. When the experimental and control groups were compared, the experimental group's final test YMS score was almost twice that of the control group, and this difference was statistically significant (p < 0.05). Conclusion: The importance of full compliance with the immunosuppressive drug regimen in improving graft function after liver transplantation is well known. The results of this study showed that liver transplant recipients who underwent ACT demonstrated higher adherence to the immunosuppressive drug regimen due to increased motivation and conscious awareness. We recommend the use of ACT to increase adherence to the immunosuppressive medication due to its effectiveness.
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    Relation between monocyte to high-density lipoprotein cholesterol ratio and prognosis in recipients after liver transplantation
    (Elsevier, 2025) Okutan, Serafettin; Saritas, Hasan; Saritas, Serdar; Bulbuloglu, Semra; Gunes, Huseyin
    Background The end-stage liver diseases require liver transplantation as the life-saving solution. It is known that monocytes/macrophages and high-density lipoprotein cholesterol (HDLC) have important contributions to the development of hepatic inflammation and oxidative stress before liver transplantation. However, the effect of monocyte/HDL-C ratio (MHR) on clinical progression and outcome in the post-transplant period are not fully understood. Our hypothesis is that the MHR value may be associated with poor vs. good outcomes after liver transplantation. Methods In our retrospective study, we included 464 liver transplant recipients. Patients' data were extracted from electronic and other paper records in our teaching/research hospital. The MHR values and other blood parameters (creatinine, total protein, albumin, etc.) were expressed as a mean and standard deviation, which were analyzed by the Pearson correlation test. The relationship between graft dysfunction and MHR was determined by ROC curve analysis. Results The mean age of liver transplant recipients was 45.8 +/- 13.7 years. Nineteen percent of patients had liver failure due to Alcoholic Fatty Liver Disease (AFLD) and 34.5 % had liver failure due to hepatitis B virus. At the end of 3 months after liver transplantation, 84.5 % of liver transplant recipients were alive, 5.8 % experienced graft rejection and 5.17 % had an infection. There was a statistically significant improvement in total protein, albumin, liver function tests, and serum creatinine values of the survivors (all p < 0.05). The MHR levels were significantly higher in patients who died after transplantation in comparison to those who survived before and after liver transplantation and these differences were statistically significant (p < 0.01). Conclusion The increased MHR values of recipients after liver transplantation correlated with their risk of survival. Furthermore, the MHR value increased with increased MELD score and the number of days of hospitalization and was not affected by gender and age. MHR was higher in patients with chronic diseases. Patients with high MHR before and after transplantation should be monitored more closely in the perioperative period.
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    The Effect of Comedy Therapy on Anxiety and Vital Signs in Liver Transplant Recipients during the Preoperative Period: A Randomized Controlled Trial
    (Wiley, 2026) Saritas, Hasan; Okutan, Serafettin; Bulbuloglu, Semra; Saritas, Serdar; Guven, Durdane Yilmaz
    Background Patients awaiting liver transplantation often experience preoperative anxiety, which may negatively influence vital signs and physiological stability. Brief, low-cost non-pharmacological interventions such as comedy therapy may help reduce anxiety and improve selected physiological parameters. This study aimed to evaluate the effect of comedy therapy on preoperative anxiety and vital signs in liver transplant recipients. Methods This randomized controlled trial was conducted between April 2024 and May 2025 at a liver transplant institute in Turkey. A total of 120 participants were randomly assigned to an intervention group (n = 60) or a control group (n = 60). During the preoperative period, the intervention group watched 10-min clips from classic Turkish comedy films, while the control group received only routine care. State-trait anxiety inventory (STAI) scores and vital signs (systolic/diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation) were measured before and after the intervention. Data were analyzed using SPSS 26 with p < 0.05 considered significant. Results In the intervention group, STAI scores decreased significantly after comedy therapy (p = 0.001), whereas no significant change occurred in the control group (p = 0.974). Mean pulse, systolic and diastolic blood pressure, and respiratory rate decreased, and oxygen saturation increased significantly in the intervention group (p < 0.05). In the control group, only a limited reduction in blood pressure was noted. Between-group comparisons revealed significant differences in respiratory rate and oxygen saturation (p < 0.05). Conclusion Comedy therapy effectively reduces preoperative anxiety and improves selected physiological parameters in liver transplant recipients. Integrating such low-cost, non-pharmacological interventions into surgical preparation may enhance psychological well-being and promote physiological stability.