From Transplant to Reamputation: A Case Report on Chronic Rejection and Innovative Treatment in Hand Allotransplantation.

Vascularized composite allotransplantation provides upper limb amputation patients with functional and aesthetic restoration but is limited by the challenges of chronic rejection. This case report highlights a patient who underwent right-hand transplantation and experienced repeated rejection episodes, chronic pain, and functional decline. Despite standard immunosuppressive regimens and innovative interventions such as fat grafting with platelet-rich plasma, chronic rejection symptoms persisted. Fat grafting demonstrated short-term improvements in skin texture and inflammation but failed to prevent progressive deterioration. Ultimately, the patient opted for reamputation, prioritizing quality of life over the prolonged burden of managing a failing graft. This case showcases the complexities of managing chronic rejection in vascularized composite allotransplantation and highlights the need for individualized, patient-centered approaches that respect autonomy and prioritize overall well-being.