Immunosuppressive drugs have been key to the success of liver transplantation and are essential components of the treatment of inflammatory bowel disease (IBD) and autoimmune hepatitis (AIH). For many but not all immunosuppressants, therapeutic drug monitoring (TDM) is recommended to guide therapy. In this article, the rationale and evidence for TDM of tacrolimus, mycophenolic acid, the mammalian target of rapamycin inhibitors, and azathioprine in liver transplantation, IBD, and AIH is reviewed. New developments, including algorithm-based/computer-assisted immunosuppressant dosing, measurement of immunosuppressants in alternative matrices for whole blood, and pharmacodynamic monitoring of these agents is discussed. It is expected that these novel techniques will be incorporate into the standard TDM in the next few years.

免疫抑制药物是肝移植成功的关键，是治疗炎症性肠病 (IBD) 和自身免疫性肝炎 (AIH) 的重要组成部分。对于许多但不是所有的免疫抑制剂，推荐治疗药物监测 (TDM) 来指导治疗。本文综述了他克莫司、霉酚酸、雷帕霉素抑制剂的哺乳动物靶点和硫唑嘌呤在肝移植、IBD 和 AIH 中 TDM 的基本原理和证据。讨论了新的发展，包括基于算法/计算机辅助的免疫抑制剂剂量、全血替代基质中免疫抑制剂的测量以及这些药物的药效学监测。预计这些新技术将在未来几年内纳入标准 TDM。