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Liver retransplantation is the only corrective long-term management for graft failure and insurmountable graft complications. Previous single-center cohorts have shown that 9%-29% of pediatric liver transplantation patients need to undergo retransplantation. 1 In Australia, since 2000 an additional 15% of children post-retransplantation have required a third and possibly fourth transplants. 2Pediatric retransplantation has previously been approached with caution. This is because of concerns about poorer graft and patient survival as well as a limited supply of donors. 1,3,4 The consensus opinion has however recently shifted. A 2020 retrospective cohort analysis of Australian and New Zealand liver transplant registry data demonstrated for children retransplanted between 2001 and 2017 actuarial graft survival of 84%, 75%, 70%, and 54% and patient survival of 89%, 87%, 87%, and 71% at 1 year, 5 years, 10 years, and 15 years, respectively. 2 This was not dissimilar to pooled survival rates for all Australasian children transplanted during that period with actuarial survival rates of 94%, 89%, 88%, and 83% at 1 year, 5 years, 10 years, and 15 years, respectively. 5 In addition, the pediatric wait list mortality for Australia and New Zealand in 2017 was 1.4%. An intention since 2002 to split livers wherever possible and improvements in organ donation have played a large role in achieving this. 5

Inflammatory myofibroblastic tumours (IMTs) are rare soft tissue tumours. Reports of gastrointestinal tract, liver and pancreas tumours are limited. The objective of this study is to identify presenting features, contributing prognostic / etiological factors and any variability in outcomes in the context of different historical treatments. We retrospectively reviewed the records of seven children treated at our hospital between 2006 and 2019 and assessed the demographic, presentation, treatment, immunohistochemistry, and outcomes of their tumours. Age range at presentation was 4 months-15 years with a male predominance. Presentations were typically due to local mass effect or incidental discovery. Systemic symptoms were rare. Outcomes were good with six out of seven stable or in remission irrespective of treatment. Surgical resection where possible is the treatment of choice. Medical therapy had good outcomes with chemotherapy acting as first line treatment when required. The only negative prognostic factor identified was local spread at the time of presentation.