**1. Introduction**

Liver transplantation has evolved as the therapy of choice for patients with end-stage liver disease. However, the waiting list for liver transplantation is growing at a fast pace, whereas the number of available organs is not growing at a proportional rate. The potential use of steatotic livers for transplant, one of the most common types of organs from marginal donors, has become a major focus of investigations. However the clinical problem is still unresolved since steatotic livers are more susceptible to ischemiareperfusion (I/R) injury and, when used, have poorer outcome than non-steatotic livers. Indeed, the use of steatotic livers for transplantation is associated with increased risk of primary non-function or dysfunction after surgery. Therefore, minimizing the adverse effects of I/R injury could improve outcomes in steatotic liver surgery, increase the number both of suitable transplantation grafts and of patients who successfully recover from liver transplantation.

The present review focuses on the complexity of hepatic I/R injury, summarizing conflicting results obtained from the literature about the mechanisms responsible for it. We also review the therapeutic strategies designed in past years to reduce I/R injury, attempting to explain why most of them have not been applied clinically. Finally, we will consider new potential protective strategies that have shown promising results for I/R injury with the potential to increase the number of liver suitable for liver transplantation.
