Abstract
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.