Mesenchymal stromal cells (MSCs) have the potential to regenerate liver tissue and treat liver diseases due to their immunomodulatory properties, differentiation ability, and paracrine functions. They secrete bioactive substances such as hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and extracellular vesicles (EV), which prevent the activation of hepatic stellate cells (HSC), break down the fibrotic extracellular matrix (ECM) and promote the growth of own liver cells. Their immunomodulatory effects change the immune environment of the liver by inducing anti-inflammatory M2 macrophages, suppressing T-cells and balancing Th17/Treg cells. Preclinical studies confirm that MSCs restore liver function and eliminate fibrosis in models of liver injury. Preliminary clinical studies show their safety and efficacy, with allogeneic MSC infusion improving survival in patients with end-stage liver disease. The main obstacles are the diversity of cell sources, low targeting accuracy and lack of standard preparation procedures. New strategies include CRISPR gene editing, exosomes delivery, and biomaterials for better targeting.