A study of craniofacial growth in infant heart transplant recipients receiving cyclosporine

Background: Cyclosporine is an effective immunosuppressive drug that has fo und 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 po ssible untoward effects of cyclosporine long-term on craniofacial growth in a group of infant heart transplantation recipients. Methods: A prospective group (n = 28) of 18 Caucasian (white) children (9 f emale and 9 male, ages 4-10 years) and 10 Hispanic children (3 female and 7 male, ages 4-10 years) were evaluated. No attempt was made for either stud y group to delineate on individuals specific country of origin. None of the subjects had undergone orthodontic therapy. All subjects had heart transpl antations before 6 months of age and followed the Loma Linda University Int ernational Pediatric Heart Transplantation Immunosuppression protocol. The primary immunosuppression agent was cyclosporine with azathioprine or metho trexate. Rescue therapy for graft rejection consisted of glucocorticoid and /or polyclonal antibody therapy. None of the subjects received the immunosu ppressant tacrolimus (FK506). Using lateral cephalometric radiography, seve n skeletal angular measurements (SNA, SNB, ANB, GoGn-SN, NA-Pog, ArGoMe, NP og-AB) were examined and compared to contemporary growth standards. Hand/wr ist radiographs were evaluated for bone age. Also, longitudinal height, wei ght, and head circumference data was obtained and compared to standardized growth and development curves. Results: Descriptive statistics were used to summarize the data. Cephalomet rically, 86% (N = 24), showed minor deviation from mean normative values. F our of the subjects (14%) exhibited cephalometric measures indicative of in dividuals with a vertical growth pattern. Analysis of the hand/wrist radiog raphs showed all but one subject to have normal bone age. Height, weight, a nd head circumference data revealed a wide range of growth percentiles for the entire group with mean percentiles in the range of 25% to 50%. Conclusions: The findings of this pilot study indicated that, in general, s keletal growth of the craniofacial complex as well as axial skeletal growth was not statistically significantly altered by the immunosuppressive regim en of cyclosporine over the time period evaluated. Further longitudinal dat a of this study's subjects may shed more light on the possible adverse effe cts of cyclosporine on craniofacial growth and development in spite of the fact that no untoward correlation was found over the time period studied.