A comprehensive review article titled "Nail abnormalities in upper extremity transplantation: Perspectives and insights from systemic diseases and organ transplantation" published by Baishideng Publishing Group highlights the often-overlooked diagnostic and prognostic value of nail changes in transplant recipients. The article, slated for online publication on March 18, 2026, synthesizes existing evidence from vascularized composite allotransplantation (VCA), systemic diseases, and solid organ transplantation (SOT). The review emphasizes that nail changes following upper extremity transplantation (UET) can serve as early and atypical signs of graft rejection. Common abnormalities reported in UET recipients include onychomadesis (shedding of the nail plate), nail dystrophy, changes in nail plate thickness, cuticular microhemorrhages, discoloration of the nail bed, and lunular alterations. Notably, onychomadesis is frequently cited as a significant indicator, often preceding other visible signs of acute or chronic allograft rejection. Beyond UET, the article explores nail pathologies observed in solid organ transplant recipients, such as those undergoing kidney and liver transplants. These patients often experience conditions like leukonychia, clubbing, Muehrcke lines, and dystrophic nails, which can be linked to immunosuppressant therapy, underlying systemic conditions, or even kidney failure post-transplant. The review underscores the importance of an interdisciplinary evaluation involving transplant surgeons, pathologists, dermatologists, and immunologists to accurately diagnose and manage these nail abnormalities. By recognizing specific patterns of nail changes, clinicians can better differentiate between immune-mediated rejection, comorbid conditions, and treatment-related effects, thereby improving surveillance and facilitating timely interventions to enhance long-term outcomes for transplant recipients.