Background <p>Hepatocellular carcinoma (HCC) is characterized by a highly immunosuppressive and heterogeneous tumor microenvironment that limits the effectiveness of current immunotherapies. Conventional two-dimensional cultures and animal models fail to fully capture patient-specific tumor–immune interactions, creating an urgent need for more physiologically relevant platforms.</p> Main body <p>This review summarizes recent advances in co-culture systems integrating patient-derived HCC organoids with defined immune cell populations to reconstruct essential features of the tumor microenvironment. We describe strategies for organoid establishment and validation, outline immune cell integration approaches, and compare static three-dimensional cultures, microfluidic organ-on-chip systems, and bioengineered multicellular platforms. We further highlight key tumor–immune interaction mechanisms that have been functionally interrogated in these systems, including immune checkpoint–mediated T-cell dysfunction, adenosine-driven metabolic suppression, and chemokine-regulated immune recruitment. Importantly, we critically evaluate current limitations, including immune cell exhaustion artifacts, lack of stromal and vascular complexity, and variability across protocols, which may affect the reproducibility and translational interpretation of these models. While emerging studies suggest potential for predicting immunotherapy responses, robust clinical validation in HCC remains limited.</p> Conclusions <p>Organoid–immune co-culture platforms represent an emerging translational framework that bridges mechanistic tumor immunology with functional precision oncology. With improved standardization and integration of multicellular bioengineering and multi-omics technologies, these systems have strong potential to guide personalized immunotherapy strategies, although further clinical validation is required.</p>