•Vascularized composite allografts (VCAs) are comprised of multiple tissue types each with a unique physiological profile.

•Inclusion of immunogenic tissues, like skin, predispose patients to graft rejection.

•The current gold standard for graft monitoring is currently biopsy, however this can be overly invasive for many recipients.

•Elucidating possible trends of blood borne markers in relation to acute rejection episodes can provide clinical decision support to VCA providers by providing a readily available and cost-effective metric for graft monitoring.

•This purpose of this study is to determine if there is a relationship between a state of acute rejection and a patient’s concurrent lymphocytic subset distribution at the time of presentation.