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

Abstract

Background: 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. Methods A prospective group ( n = 28) of 18 Caucasian (white) children (9 female 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 study group to delineate on individuals specific country of origin. None of the subjects had undergone orthodontic therapy. All subjects had heart transplantations before 6 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 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. Results Descriptive statistics were used to summarize the data. Cephalometrically, 86% ( N = 24), showed minor deviation from mean normative values. Four of the subjects (14%) exhibited 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% to 50%. Conclusions The findings of this pilot study indicated that, in general, skeletal growth of the craniofacial complex as well as axial skeletal growth was not statistically significantly altered by the immunosuppressive regimen of cyclosporine over the time period evaluated. Further longitudinal data of this study’s subjects may shed more light on the possible adverse effects of cyclosporine on craniofacial growth and development in spite of the fact that no untoward correlation was found over the time period studied.