Cyclosporine is an effective immunosuppressive drug that has found widespread application in organ transplantation. However, a few studies have implicated cyclosporine as adversely affecting craniofacial growth in the pediatric population. The purpose of this study was to evaluate the possible untoward effects of cyclosporine long-term on craniofacial growth in a group of infant heart transplantation recipients. A prospective group (n=28) of eighteen Caucasian children (9 female and 9 male, ages 4-10 years) and ten Hispanic children (3 female and 7 male, ages 4-10 years) were evaluated. None of the subjects had undergone orthodontic therapy. 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. Rescue therapy for graft rejection consisted of glucocorticoid and/or polyclonal antibody therapy. None of the subjects received the immunosupressant 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 growth standards. Hand/wrist radiographs were evaluated for bone age. Also, longitudinal height, weight, and head circumference data was obtained and compared to standardized growth and development curves. Descriptive statistics was used to summarize the data. Cephalometrically, 86% (N=24), showed minor deviation from mean normative values. Four subjects (14%) did show cephalometric measures indicative of individuals with a vertical growth pattern. Analysis of the hand/wrist radiographs showed all but one subject to have normal bone age. Height, weight, and head circumference data revealed a wide range of growth percentiles for the entire group with mean percentiles in the range of 25%-50%. The findings of this pilot study indicate that, in general, skeletal growth of the craniofacial complex as well as axial skeletal growth was not significantly altered by the immunosuppressive regimen of cyclosporine over the time period evaluated. Further longitudinal data compiled from this study may shed more light on the possible adverse effects of cyclosporine on craniofacial growth and development.

LLU Discipline



Orthodontics and Dentofacial Orthopedics


Graduate School

First Advisor

Roland D. W. Neufeld

Second Advisor

Marti Baum

Third Advisor

Joseph M. Caruso

Fourth Advisor

R. David Rynearson

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

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



Page Count

vi; 25

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