Background: Long-term outcomes after Kasai portoenterostomy (KPE) remain poor, with 20-year native liver survival of 20–32%. In India, delayed presentation limits KPE utility, and LT after KPE is associated with higher complications. Using Indian Liver Transplant Registry (ILTR) data, outcomes of primary versus salvage LT in biliary atresia were compared. Method: Retrospective analysis of prospectively collected multicentric data from the ILTR. Pediatric LT recipients (<18 years) with BA were included. Analysis was done using SPSS v26.0. Results: Of 679 children who underwent LT for BA, 42.4% were BA-unoperated (upfront LT) and 57% had prior KPE. Living donor LT accounted for the majority. The median age at LT was 10.8 months (IQR 7.2–18), and the mean graft-to-recipient weight ratio was 3.07±1.08. Postoperative vascular complications occurred in 8.7%, including portal vein thrombosis/stenosis in 4.6% and hepatic artery thrombosis in 2.4%, while biliary complications occurred in 3.2%. On subgroup analysis, the post-KPE cohort was older at LT (12 vs 9.6 months, p<0.001), had higher weight (7.1 vs 6.7 kg, p<0.001), lower decompensation rates (0.5% vs 6.3%, p<0.001), and required fewer reduced grafts (13.6% vs 22.5%, p=0.003). Vascular, biliary complications, ICU stay, hospital stay, and sepsis rates were comparable between groups. Three-month survival was 94% with no difference between groups (p=0.6). On multivariate analysis, decompensation at LT (OR 2.87; 95% CI 1.11–7.38; p=0.03) and lower weight (6.7 vs 7.2 kg, p=0.08) were important mortality determinants. Children ≤6 kg had higher mortality (86.1% vs 93.8%, p=0.002), higher hepatic artery thrombosis (4.2% vs 1.8%, p=0.09), and re-exploration rates (9% vs 5.2%, p=0.08). More upfront LT children were ≤6 kg (32.6% vs 24%, p=0.015), highlighting greater vulnerability. Conclusion: ILTR showed comparable survival after upfront or post-KPE LT. Better nutrition post-KPE supports KPE as the preferred bridge to LT.