Research Article Smoking, Gender, and Overweight Are Important Influencing Factors on Monocytic HLA-DR before and after Major Cancer Surgery Gunnar Lachmann, 1 Clarissa von Haefen, 1 Johannes Kurth, 1 Fatima Yuerek, 1 Klaus-Dieter Wernecke, 2 and Claudia Spies 1 1 Department of Anesthesiology and Operative Intensive Care Medicine, Charit´ e - Universit¨ atsmedizin Berlin, Campus Charit´ e Mitte and Campus Virchow-Klinikum, Berlin, Germany 2 Sostana GmbH, Berlin, Germany Correspondence should be addressed to Claudia Spies; claudia.spies@charite.de Gunnar Lachmann and Clarissa von Haefen contributed equally to this work. Received 20 February 2017; Revised 24 May 2017; Accepted 9 July 2017; Published 8 August 2017 Academic Editor: Giuseppe Valacchi Copyright © 2017 Gunnar Lachmann et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 aſter major surgery. Influencing factors of mHLA-DR such as age, overweight, diabetes, smoking, and gender remain unclear. Methods. We analyzed 20 patients aſter 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 ( = 0.010) and a trend towards lower levels on pod5 ( = 0.056) in smokers. Lower mHLA-DR was seen in men on pod3 ( = 0.038) and on pod5 ( = 0.026). Overweight patients (BMI > 25 kg/m 2 ) had lower levels of mHLA-DR on pod3 ( = 0.039) and pod4 ( = 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. 1. Background Antigen-presenting cells, that is, macrophages, dendritic cells, and activated natural killer cells, express human leuko- cyte antigen D related (HLA-DR) on their surface which is crucial for immunologic competence [1, 2]. Immunogenic peptides processed from ingested pathogens, for example, bacterial proteins, are presented to T cells by HLA-DR. Specific T cell antigen receptors recognize the HLA-DR- antigen complex and subsequently activate the T cells [3]. us, the expression of HLA-DR reflects the functional state of antigen-presenting cells. Downregulation of HLA-DR expression on monocytes (mHLA-DR) emerged as a general biomarker of impaired immunity up to immune suppression which can predict out- come [1, 4, 5]. In the state of reduced mHLA-DR expression, the function of monocytes and T cell activation is severely restricted [6] which results in up to five times higher risk for infections and septic complications [7–9]. A reduced mHLA-DR expression is associated with sepsis, pneumonia, and surgical site infections [9–11] and furthermore seen in patients aſter thoracic [12, 13] and major visceral surgery [1, 3, 14], in trauma patients [15, 16] and patients with burn injury [17]. Hindawi BioMed Research International Volume 2017, Article ID 5216562, 7 pages https://doi.org/10.1155/2017/5216562