Cross-reactivity among nonsteroidal anti-inflammatory drugs (NSAIDs) creates a significant clinical difficulty, especially in patients with NSAID hypersensitivity. These reactions are based on cyclooxygenase-1 (COX-1) inhibition and non-immunoglobulin E (IgE)-mediated reactions. COX-1 inhibition leads to dysregulation of arachidonic acid metabolism, with decreased prostaglandin synthesis and increased leukotriene production. Clinically, cross-intolerant reactions manifest in different phenotypes, including NSAID-exacerbated respiratory disease (NERD), NSAID-induced urticaria/angioedema (NIUA), and NSAID-exacerbated cutaneous disease (NECD). In contrast, true allergic reactions—such as single-NSAID-induced urticaria/angioedema and anaphylaxis (SNIUAA) and single-NSAID-induced delayed hypersensitivity reactions (SNIDHR)—are immunologically mediated and drug-specific. These phenotypes differ in underlying conditions, clinical manifestations, and patterns of NSAID tolerance. Paracetamol is generally considered a safer alternative due to its weak COX-1 inhibition; however, reactions may still occur, particularly at higher doses. Selective COX-2 inhibitors are usually better tolerated, however their safety should be confirmed, preferably through controlled drug provocation testing due to sporadic reactions in cross-intolerant patients. Understanding the distinction between pharmacologically mediated cross-intolerance and true allergic reactions is essential for accurate diagnosis, risk stratification, and therapeutic decision-making. This review summarizes current evidence on the mechanisms underlying NSAID hypersensitivity, analyzes the tolerability of paracetamol and alternative analgesics, and discusses practical management strategies to reduce the risk of adverse reactions.

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4–16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4–17.7) vs. LVAD: 11.2 (7.3–14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.

Introduction: Heart transplantation (HTx) remains the definitive treatment for selected patients with advanced heart failure. The early post-transplant period is characterized by substantial morbidity and requires intensive surveillance. The aim of this study was to describe the clinical course of the first 100 heart transplant recipients treated at our newly established center, with particular emphasis on in-hospital outcomes and the 12-month follow-up. Methods: We retrospectively analyzed 100 consecutive patients who underwent orthotopic HTx between February 2021 and May 2023 at our center. Demographic, clinical, hemodynamic, laboratory, treatment, and post-transplant follow-up data were collected. The follow-up assessment included survival, rejection, infectious complications, renal replacement therapy (RRT), heart failure decompensation, hospitalizations, outpatient visits, and changes in pharmacotherapy. Cox proportional hazards regression and Receiver Operating Characteristic (ROC) analyses were also performed to assess factors associated with 12-month mortality. Results: The study population comprised 82 (82%) men and 18 (18%) women with a median age of 54 years (IQR, 45–64). The in-hospital course was characterized by substantial early morbidity: 17 patients (17%) died during the index hospitalization, with a median time to death of 17 days (IQR, 3–78). RRT was required in 44% of patients. Among hospital survivors, the median length of hospital stay was 43 days and the median ICU stay was 7 days. During the 12-month follow-up, clinically significant cellular graft rejection (grade ≥ 3) occurred at least once in 51% of patients, infectious complications in 45%, and one patient underwent retransplantation. The twelve-month all-cause mortality was 23%. Patients had a mean of 8 planned hospitalizations, 0.4 unplanned admissions, and 1.3 outpatient visits per patient. Exploratory analyses identified possible associations between selected pre-transplant variables and 12-month mortality. Conclusions: The first 100 HTx recipients treated at the newly established center experienced a clinically demanding in-hospital course, with a 17% in-hospital mortality. After discharge, the first year remained characterized by frequent cellular rejection incidence, and infectious complications. The twelve-month survival was 77%. These findings provide a comprehensive description of the early in-hospital and 12-month clinical course of a newly established Htx program.