Since the mid 1980’s, Cyclosporine has proved to be an effective immunosuppressive drug and now has a widespread application in organ transplantation. Several studies, however, have implicated cyclosporine as adversely affecting craniofacial growth in the pediatric population. 16,18 The purpose of this follow-up study was to continue to evaluate the possible untoward effects of long-term use of cyclosporine on craniofacial growth in a group of infant heart transplantation recipients by re-evaluating as many subjects as possible from the original study and evaluating new subjects. A pediatric group (N=13) was composed of six Caucasian subjects (4 male and 2 female, ages 11 years-1 months to 18 years-5 months) and seven of Hispanic descent (7 males, ages 4 years-10 months to 15 years-11 month). Two Caucasian subjects and one Hispanic subject participated in the 2001 study, while one Caucasian subject and one Hispanic subject participated in the initial 1996 and the 2001 study, comprising the longitudinal portion of the sample. All subjects had heart transplantation before six months of age and followed the Loma Linda University International Pediatric Heart Transplantation immunosuppression protocol. The primary immunosuppression agent was cyclosporine with azathioprine or methotrexate. Using lateral cephalometric radiography, seven skeletal angular measurements (SNA, SNB, ANB, GoGn-SN, NA-Pog, ArGoMe, Npogvn AB) were examined and compared to contemporary cephalometric norms. Hand/wrist radiographs were evaluated for bone age. Also, longitudinal height, weight, and head circumference data was obtained and compared to standard NCHS growth and development curves. Longitudinal subjects (returning 1996, 2001 study participants) were also evaluated for retrognathic craniofacial growth vector trends via cephalometric superimpositions. Statistical analysis, and descriptive statistics were used to summarize the data. Cephalometrically, the difference between the Caucasian mean norms and the 2006 recorded mean value ranged from 0.3 to 3.3 degrees for the seven angular parameter measurements. The difference between the mean norms and the 2006 recorded mean values for the Hispanic group ranged from 0.0 to 4.0 degrees for six of the seven angular parameter measurements, with the seventh angular parameter value, A-B Plane Angle, differing by 6.0 degrees. The majority of the individual subjects, and cumulative mean values were within two standard deviations of the norm for each measurement. These findings would suggest a relatively normal pattern of facial growth. None of the five longitudinal subjects evaluated exhibited a mandibular growth pattern tending toward retrognathia. Analysis of the hand/wrist radiographs showed six subjects (average age 13 years-9 months) to have normal bone age, while seven subjects (average age 9 years-9 months) showed delayed bone age. Height, weight and head circumference data revealed a wide range of growth percentiles for the entire group and suggested a tendency toward delayed statural development. The findings of this longitudinal study concur with those of the 1996 pilot study, and the 2001 follow-up study, suggesting that skeletal growth of the craniofacial complex of infant heart transplant recipients receiving cyclosporine generally did not differ from normative data.

LLU Discipline

Orthodontics and Dentofacial Orthopedics


Orthodontics and Dentofacial Orthopedics


Graduate Studies

First Advisor

R. David Rynearson

Second Advisor

Joseph M. Caruso

Third Advisor

Roland D. W. Neufeld

Fourth Advisor

Tamara Shankel

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Heart Transplantation -- in infancy and childhood; Maxillofacial Development; Cyclosporine -- adverse effects.



Page Count

viii; 58

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives