Vascularized composite allograft transplantation is an important method in tissue repair and reconstruction. However, the side effects of immunosuppressive therapy remains the great burden of these patients and lacks an appropriate solution. There is a growing attention to the emerging cell therapy, like mesenchymal stem cell, especially adipose derived mesenchymal stem cell,in combine with immunosuppressive agents which may prolong the graft survival and reduce the side effects of immunosuppressor. The underlying mechanism of adipose derived mesenchymal stem cell therapy may include the paracrine of immunomodulatory molecules, the induction of regulatory T cells, mixed chimerism and the reduction of ischemia reperfusion injury. Moreover, the safety, timing and dosage of adipose derived stem cell should be tested and determined before clinical application.