Kidney transplanted patients need immunosuppressant therapies. Therapeutic drug monitoring approaches produce the optimal clinical outcome is still under debate. This review details strength and limits of methods available: immunoassay and chromatography-based. Liquid chromatography with mass spectrometry detection is a major breakthrough in therapeutic drug monitoring of immunosuppressive agents and is considered as the method of choice in therapeutic drug monitoring (TDM) of immunosuppressants. Despite the initial high cost for the instrumentation, HPLC-MS is more cost effective than microparticle enzyme immunoassay. The main important features of LC-MS/MS methodology for immunosuppressive drugs are the shortened analysis time, an increased throughput, higher selectivity, specificity, and sensitivity, and low cost of analysis.
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