S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7007
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               April 3, 2019
                                ___________
 
 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.
              

                                                            LBD10835-01-9

 A. 7007                             2
 
   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.
   §  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.
   §  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.
   § 4. This act shall take effect immediately.