Abstract: Mesenchymal stem cell-derived exosome (MSC-Exo) represented an emerging cell-free therapeutic tool characterized by low immunogenicity and excellent biomolecule delivery capacity, demonstrating broad prospects in the treatment of liver diseases. MSC-Exo could suppress pro-inflammatory responses, enhance anti-inflammatory activity, and exert their ef fects through the delivery of functional microRNA (miRNA). This article reviewed the research progress on MSC-Exo in disease models such as hepatic ischemia-reperfusion injury, liver f ibrosis, liver failure and hepatocellular carcinoma.