Introduction: Biliary atresia (BA) is a progressive fibro-obliterative disorder of the extrahepatic bile ducts, representing the most common indication for pediatric liver transplantation. Despite extensive research, its etiology remains obscure, with proposed mechanisms ranging from viral triggers to autoimmune and developmental anomalies. Method: This is a retrospective study carried over 10 years (Jan 2013-Dec 2022). We investigated in 33 BA patients, with emphasis on 9 cases of cytomegalovirus (CMV) co-infection. Result: Our findings reveal no difference in long term outcome in CMV positive patients. Conclusion: These observations suggest that BA pathogenesis may involve multiple and separate mechanisms affecting the extrahepatic biliary tree warranting further investigation into multiple etiopathogenic pathways.