Chronic liver diseases are associated with high mortality rates and significant financial burdens. Current treatments, such as liver transplantation, are limited by the availability of donors and the risks associated with surgery. Mesenchymal stem cells (MSCs) and their extracellular vesicles (EVs) have emerged as promising therapeutic options due to their paracrine effects and immunomodulatory properties. MSC-EVs, in particular, have shown potential in maintaining tissue homeostasis and promoting liver regeneration. This review provides an overview of the sources, physiological roles, and biochemical capabilities of MSC-EVs, focusing on their therapeutic applications in various chronic liver diseases. The review highlights the mechanisms by which MSC-EVs reduce inflammation, inhibit fibrosis, and promote liver regeneration, offering new insights into the treatment of chronic liver diseases. Despite the promising results, challenges such as standardization of preparation methods, purification techniques, and long-term viability need to be addressed for clinical translation. Overall, MSC-EVs show great potential in treating liver disorders, and further research is needed to optimize their therapeutic efficacy.Chronic liver diseases are associated with high mortality rates and significant financial burdens. Current treatments, such as liver transplantation, are limited by the availability of donors and the risks associated with surgery. Mesenchymal stem cells (MSCs) and their extracellular vesicles (EVs) have emerged as promising therapeutic options due to their paracrine effects and immunomodulatory properties. MSC-EVs, in particular, have shown potential in maintaining tissue homeostasis and promoting liver regeneration. This review provides an overview of the sources, physiological roles, and biochemical capabilities of MSC-EVs, focusing on their therapeutic applications in various chronic liver diseases. The review highlights the mechanisms by which MSC-EVs reduce inflammation, inhibit fibrosis, and promote liver regeneration, offering new insights into the treatment of chronic liver diseases. Despite the promising results, challenges such as standardization of preparation methods, purification techniques, and long-term viability need to be addressed for clinical translation. Overall, MSC-EVs show great potential in treating liver disorders, and further research is needed to optimize their therapeutic efficacy.