Late nail lesions rejection in a stable bilateral forearm allograft at 60 months posttransplantation

We present a case of late nail lesions rejection in a stable and compliant bilateral forearm allograft at 60 months posttransplantation, confirming that rejection features in vascularized composite tissue allotransplantation are more heterogeneous with multiple clinical implications, despite apparently appropriate immunosuppressive treatment. Our observations may help to better characterize and to fully understand the onset and dynamics of skin rejection after human hand allotransplantation; nevertheless, further investigations are required, and careful monitoring of the grafts by direct inspection is advisable in all patients to start rapidly appropriate and effective treatment.