Nerve regeneration and functional recovery are the ultimate goals of composite tissue allografts like hand transplants. Published and presented reports indicate that thirteen hands have been transplanted onto ten recipients around the world. The first Louisville recipient currently has the longest surviving hand transplant in the world at three years after surgery. Herein we present the results of functional testing at the three year post transplantation follow up. Clinical evidence of motor return in the transplanted intrinsics as confirmed by electrophysiologic testing revealed the following: Adductor pollicis (3/5), Abductor pollicis (2/5), first dorsal interosseous (1/5), and Lumbricals 3-4/FDM (2/5). Wrist dorsiflexion, volarflexion, radial and ulnar deviation were 4+/5. Grip strength at position II on Jamar dynamometer was 12 lb. Lateral pinch was 4.5 lb and two-point pinch was 1 lb. Evaluation of integrated upper extremity and global hand function by the Carroll test revealed a score of 61/99. He can perform such activities including tying shoelaces, dressing, turning book and newspaper pages, writing, throwing a ball, picking up checkers or poker chips and use both his hands in activities of daily living and his occupation. Physical therapy initially included electrical stimulation, anti-claw splinting, resistance exercises and dynamic splinting. He now reports once every two weeks for stretching, strengthening and resistance exercises. He no longer requires splint wear. He has shown rapid progression of Tinel’s sign with return of temperature, pain and pressure sensation to the hand and fingers. He can localize touch to thumb, ring and small; long and index still reversed (can localize on long except for tip). Perception when touched demonstrates different grades of tingling and pressure. Semmes-Weinstein monofilament scores at tips of fingers: 3.61 in the index, middle and ring fingers, 3.22 in the thumb and 3.84 in the little finger. Results of testing showed the most improvement in the thumb since last testing in September 2001 (3.84 to 3.22). There have been no episodes of ulceration. Static two-point discrimination is greater than 15 mm. There was no evidence of retardation of nerve regeneration (as measured by advancing Tinel’s sign) during the rejection episodes. The initial trial period of experimental human hand transplantation has proved successful far beyond expectations. At the three year time point, function after hand transplantation has mirrored that achieved three or more years after forearm replantation, and is superior to that after prostheses.