S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5179

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 12, 2015
                               ___________

Introduced  by  M. of A. PEOPLES-STOKES -- read once and referred to the
  Committee on Higher Education

AN ACT to establish a Center for Transplantation and Immunology Research
  at the University at Buffalo  and  Erie  County  Medical  Center;  and
  making an appropriation therefor

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Legislative determinations. Kidney disease  in  the  United
States  is  fast  becoming  epidemic in character. Due to the increasing
incidence of both diabetes and hypertension in the  general  population,
chronic renal disease affects an estimated 16.8% of adults aged 20 years
and  older.  As of 2008, there were over 500,000 people on dialysis more
than 300,000 of who have diabetes and hypertension as  their  underlying
cause. The cost to society of treating end-stage renal disease (ESRD) in
2008  was 39.46 billion dollars. The cost to the individual patient is a
higher mortality and shorter life span  at  all  ages  compared  to  the
general  population.  In  the absence of effective therapies for chronic
kidney disease, patients are left with the choice of either dialysis  or
transplantation.
  Kidney transplantation has become the treatment of choice for patients
with  end  stage  renal disease (ESRD) providing improved survival rates
and a better quality of life. In  addition,  transplantation  represents
the most cost-effective form of ESRD therapy once the allograft survives
more  than 3 years. As immunosuppressive therapies for kidney transplan-
tation evolved to include more potent and specific therapies, short-term
(1 year) patient and graft survival rates have continuously improved. It
is not unusual to expect 1 year success  rates  of  over  90%.  However,
these  short  term improvements have not translated into improved longer
survival rates.  The expected survival of kidney transplants for  living
donors  remains at 18-20 years and for deceased donor organs 8-10 years;
rates which have not significantly improved over the past 20 years.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08345-01-5
              

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  Currently, the most important challenge in  renal  transplantation  is
promoting  the  long-term kidney allograft function. Eventually many, if
not all, transplanted kidneys develop  a  progressive  fibrotic  process
that affects both the interstitium and vasculature.  This renal fibrosis
eventually  leads  to renal failure, an increased rate of cardiovascular
disease and mortality and the need for  reinstituting  dialysis.  Today,
the  most  rapidly  increasing  group of patients requiring a new kidney
transplant is those whose previous transplant has failed.
  It is becoming increasingly clear that there is  no  single  cause  of
kidney  transplant fibrosis rather this process culminates from a myriad
of etiologies. One of the major challenges to delivering effective tran-
splant care is the difficulty in assessing  an  individual's  particular
requirements  for  adequate  immunosuppression.  In  of itself, too much
immunosuppressive therapy in the form of calcineurin inhibitors leads to
renal fibrosis and is felt to be a major cause of long-term graft  fail-
ure. On the other hand, too little immunosuppression is now being recog-
nized  as  a  leading  cause  of  unrecognized  and  slowly  progressive
rejection which also leads to allograft fibrosis indistinguishable  from
calcineurin  toxicity. Moreover, subtherapeutic dosing of immunosuppres-
sive drugs may lead to the formation of antibodies directed against  the
newly  transplanted  kidney  which  may be the cause of over 50% of late
graft failures. Thus, understanding the biological effects of  available
therapies, their effects on renal fibrosis and their optimal therapeutic
"windows"  would greatly advance our ability to promote long-term kidney
transplant survival.
  The mission of the Center for Transplantation and Immunology  Research
established  pursuant  to this act is to advance the longevity of kidney
organ transplants through improved knowledge  of  immunology,  pathology
and therapeutics.
  S  2.  Center  for  Transplantation and Immunology Research. 1.  There
shall  be  established  a  Center  for  Transplantation  and  Immunology
Research  (CTIR)  at  the  University at Buffalo and Erie County Medical
Center. The CTIR shall allow for collaborations amongst laboratories  to
provide  insights  and  approaches  to understanding and improving renal
fibrosis. The CTIR shall provide a vehicle for  educational  experiences
for  undergraduates  as  well  as graduate students at the University of
Buffalo.   The CTIR shall include both  basic  and  clinical  scientists
working together with practicing physicians and surgeons. The CTIR shall
also serve as a means to compete for extramural funding through individ-
ual  investigator's  grants or through larger program projects in trans-
plantation.
  2. Research by the CTIR shall include but not be limited to:
  (a) Immunology and understanding the role of B cells  in  transplanta-
tion.
  (b)  Pathology and understanding the progression of renal graft fibro-
sis.
  (c) Therapeutics and individualizing immunosuppressive therapy.
  3. There shall be an administrative director responsible  for  coordi-
nating  the  research  activities amongst the individual laboratories as
well as preparing and submitting grants.
  4. In addition to the funding received pursuant to this act, the  CTIR
shall  apply for funding through philanthropic sources earmarked for the
development of transplantation at Erie County Medical Center.
  5. Funds appropriated pursuant  to  this  act  shall  be  administered
through  the  University of Buffalo Foundation Services Inc. with desig-

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nated administrators at Erie County Medical Center acting as responsible
directors.
  S  3.  Appropriation.  The  state of New York shall appropriate during
each fiscal year for three years to the Center for  Transplantation  and
Immunology  Research  an  amount of $227,333.34 from the general fund to
pay the expenses  of  the  Center  for  Transplantation  and  Immunology
Research  including  but not limited to the salary of the administrative
director and lab technicians, animal costs, luminex  assays,  laboratory
supplies and equipment.
  S 4. This act shall take effect immediately.