A review on decellularization scaffolding for liver regeneration in transplantation

Chronic liver disease constitutes a major global health burden, driven largely by complications of cirrhosis, viral hepatitis and hepatocellular carcinoma. While liver transplantation remains the current definitive treatment, its impact is constrained by organ scarcity, strict eligibility criteria, and lifelong immune-related complications. Through comparison of transplant strategies and decellularization-recellularization protocols, this review evaluates the translational potential of decellularized liver scaffolds, with particular emphasis on their feasibility and reported outcomes in surgical transplantation. Decellularization approaches varied across studies, with differences in preferred cell sources and recellularization outcomes. Thrombogenicity and biliary system reconstruction remain key challenges requiring further investigation. Perfusion-based recellularization in bioreactor systems, provides controlled cell seeding and dynamic culture conditions. In this context, segmental or split liver scaffolds may serve as a viable model for future translational studies. Overall, decellularized liver scaffolds represent a promising bridging strategy to address the current limitations. However, there is heterogeneity between protocols and important translational barriers remain. Further research is required to define the optimal methods through validation in large-animal transplantation studies.