Cyclosporine is an effective immunosuppressive drug that has found widespread application in organ transplantation. A couple of studies, however, have implicated cyclosporine as adversely affecting craniofacial growth in the pediatric population. 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 prospective group (N=29) of eighteen Caucasian subjects (7 female and 11 male, ages 6-15 years) and eleven Hispanic subjects (3 female and 8 male, ages 5-15 years) were evaluated in this study. Eleven of the 29 subjects (8 Caucasian and 3 Hispanic) participated in the original 1996 study and eighteen/29 were new subjects bringing the combined sample size to 46 subjects (28 Caucasian and 18 Hispanic). None of the subjects had undergone orthodontic therapy. All subjects had heart transplantations 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. Rescue therapy for graft rejection consisted of glucocorticoid and/or polyclonal antibody therapy.

None of the subjects received the immunosuppressant tacrolimus (FK506). Using lateral cephalometric radiography, seven skeletal angular measurements (SNA, SNB, ANB, GoGn-SN, NA-Pog, ArGoMe, Npog-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 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, 78% (14 of 18) of the new subjects, showed minor deviations from mean normative values. Four new subjects (22%) did exhibit cephalometric values indicative of individuals with a vertical growth pattern, but this may not be any different than a random sample of non-medically compromised subjects. Of the eleven longitudinal subjects evaluated, three exhibited a mandibular growth pattern tending toward retrognathia. Analysis of the hand/wrist radiographs showed all but three subjects to have normal 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 indicated that skeletal growth of the craniofacial complex and axial skeletal growth generally did not differ more than two standard deviations from normative data. The role of cyclosporine and its possible adverse effects on craniofacial growth and development needs to be evaluated via additional longitudinal data compilation and analysis over a greater length of time.

LLU Discipline

Orthodontics and Dentofacial Orthopedics


Orthodontics and Dentofacial Orthopedics


Graduate School

First Advisor

R. David Rynearson

Second Advisor

Marti Baum

Third Advisor

Joseph M. Caruso

Fourth Advisor

Jay S. Kim

Fifth Advisor

Roland D. W. Neufeld

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Heart Transplantation -- in infancy & childhood; Maxillofacial Development; Cyclosporine -- adverse effects; Craniofacial Abnormalities.



Page Count

ix; 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