The merger of Buffalo's two kidney transplant centers will immediately make the combined program the busiest in upstate New York.
A new $27 million Regional Center of Excellence in Transplantation and Kidney Care at Erie County Medical Center is opening in stages, combining the programs at ECMC and Kaleida Health.
The latest milestone recently occurred with the completion of a modern building to house expanded services for patients on dialysis.
Physician leaders say the merged center will enjoy a rare opportunity to build a transplant program that can attract more living organ donors and, as a result, increase the number of kidney transplants, expand research and bring together a large enough team to do more kidney-pancreas transplants.
"We have a chance to develop a robust and big program," said Dr. Mark Laftavi, who is expected to serve as surgical director of the program.
The Buffalo General kidney transplant center has been the busier of the two in recent years, performing 57 cases in 2010, while ECMC did 33, according to the Organ Procurement and Transplant Network. Officials estimate the combined program can grow to handle 150 to 200 transplants a year.
Strong Memorial Hospital in Rochester, by comparison, did 80 kidney transplants in 2010, and New York-Presbyterian Hospital/Columbia University Medical Center in Manhattan, the busiest program in the state, did 233.
The modest size of the programs here hurt their ability to mount research programs that could obtain much private or public funding, or participate in multicenter trials of new drugs and techniques, according to officials. Research into antirejection medications can improve the quality and reputation of a transplant center.
The smallness of the programs also held back efforts to identify potential living donors and expand services to other organ transplants, they said. This is important because kidney transplant success rates with deceased donors generally are lower than those with living donors, and there is a limited supply of organs from deceased donors.
Laftavi envisions creating a center for transplant immunology to study better ways to prevent rejection of organs.
"We have good researchers in Buffalo at the hospitals, at the University at Buffalo, at Roswell Park Cancer Institute, but they are not connected well. We need to collaborate," said Laftavi, currently chief of transplant services at Kaleida Health's Buffalo General Hospital.
Only about one-third of kidney transplants in Buffalo in recent years have come from living donors. That's considerably less than many of the busier transplant centers in the nation.
"This is too low, and we have to improve it," Laftavi said. "We need to build a culture in the program of using live donors."
Dr. Brian Murray, who will serve as overall program director of the center, said the combined center will have the manpower and a more streamlined process to more thoroughly investigate more potential living donors, including those who in the past might have been rejected.
In addition, he said, it's hoped the new center will attract patients from throughout the region, who went elsewhere for transplants in the past.
The transplant center is considered the first significant combination of medical services since ECMC and Kaleida Health agreed to collaborate in 2008 under the Great Lakes Health System parent organization.
A merger of the programs, an idea advocated for many years, would be complex under any circumstances. The hospitals operated with two separate administrative and medical transplant staffs, as well as different unions representing nurses and other workers. To make matters even more challenging, the relationship between the transplant centers had been marked by aggressive competition.
The effort required compromises, officials said.
A search is under way to recruit a physician to serve as vice president of transplant services at the medical center. Dr. Oleh Pankewycz, administrative chief and medical director of the Kaleida Health kidney transplant program, is expected to work as medical director of the combined center.
In a rare break from usual policy, a committee representing ECMC's medical staff granted Laftavi an exemption from a requirement that the hospital's physicians be board-certified, meaning the doctor has special training in a particular field and passed an exam to prove knowledge of it. Most international medical graduates need to complete some required training in this country before they are able to take a particular specialty board's exam.
Laftavi, who did much of his medical training in France and Iran, received the exemption based on his training abroad and past experience.
Dr. George Blessios, who headed transplantation at ECMC, will focus on a vascular access program that specializes in care of the site on the body where blood is removed and returned during dialysis, Murray said.
Buffalo's two programs do only a handful, if any, of kidney-pancreas or pancreas-only transplants each year, a situation that Laftavi and Murray said they hope to correct.
"You need more people, so that one team of surgeons and others can harvest the donor organ and another group can perform the kidney-pancreas transplant," Laftavi said.
In addition, Murray noted that post-operative management of kidney-pancreas transplant recipients is more complex. With the addition at ECMC by the spring of an inpatient unit dedicated to transplant patients, the center will be better positioned to handle more complicated cases, he said.
Longer term, officials express optimism that the combined program can grow enough to transplant other organs, such as the liver or, if it proves successful in studies, perform islet transplantation.
"Expansion into other organs would be a costly proposition and would have to make sense for the state to approve. We would have to show there's a need," said Murray, noting that liver transplants are currently available in Rochester.
"It's something we can consider in the future. Our goal, for now, is to concentrate on creating a great kidney-pancreas program," he said.
Patients involved in the transplant community praised the merger.
"I'm relieved that finally we'll have one excellent program with the potential for growth," said Patti Merritt, a kidney transplant recipient and one of the founders of the Western New York Kidney Connection, which, through its website -- www.wnykidneyconnection.org -- helps people who need kidney transplants find others willing to donate an organ.
Kidneys clean the body's blood of harmful wastes. When people with diabetes experience kidney failure, they must undergo a kidney transplant or dialysis, a procedure that performs the function of the kidneys.
The ECMC and Kaleida Health programs have comparable recent survival data. Quality is measured by whether the transplanted organ is functioning after one and three years, and whether the patient is alive after one and three years.
The most recent patient survival rates show Buffalo General at 95.8 percent after one year and 92.7 percent after three years, and ECMC at 95.2 percent after one year and 88.7 percent after three years, according to the Scientific Registry of Transplant Recipients.
The national average is 96.8 percent for one year and 91.9 percent for three years.