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Background   Monocytic human leukocyte antigen D related (mHLA-DR) is essential for antigen-presentation. Downregulation of mHLA-DR emerged as a general biomarker of impaired immunity seen in patients with sepsis and pneumonia and after major surgery. Influencing factors of mHLA-DR such as age, overweight, diabetes, smoking, and gender remain unclear.Methods   We analyzed 20 patients after esophageal or pancreatic resection of a prospective, randomized, placebo-controlled, double-blind trial (placebo group). mHLA-DR was determined from day of surgery  (od)  until postoperative day  (pod) 5 . Statistical analyses were performed using multivariate generalized estimating equation analyses (GEE), nonparametric multivariate analysis of longitudinal data, and univariate post hoc nonparametric Mann–Whitney tests.Results   In GEE, smoking and gender were confirmed as significant influencing factors over time. Univariate analyses of mHLA-DR between smokers and nonsmokers showed lower preoperative levels ( p  = 0.010) and a trend towards lower levels on  pod5  ( p  = 0.056) in smokers. Lower mHLA-DR was seen in men on  pod3  ( p  = 0.038) and on  pod5  ( p  = 0.026). Overweight patients (BMI > 25 kg/m 2 ) had lower levels of mHLA-DR on  pod3  ( p  = 0.039) and  pod4  ( p  = 0.047).Conclusion   Smoking is an important influencing factor on pre- and postoperative immune function while postoperative immune function was influenced by gender and overweight. Clinical trial registered with  ISRCTN27114642 .

Smoking, Gender, and Overweight Are Important Influencing Factors on Monocytic HLA-DR before and after Major Cancer Surgery