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Physical performance of kidney transplanted patients in challenging environments, such as deserts., has been poorly studied. Six kidney transplanted (T: 5 males, 1 female; 45 +/- 6 yrs) and 8 control (C: 5 males, 3 females; 49 +/- 13 yrs) subjects participated in a 5-day desert trek. Blood pressure, hydration status (Height(2)/Rz by bioimpedance), heart rate, energy expenditure (by SenseWear Pro Armband) and walking velocities were recorded during each daily trekking stage (GPS-assisted wearable devices). Systo-diastolic blood pressure did not differ between C (119/77 +/- 12/8 mmHg) and T (121/77 +/- 10/6 mmHg) groups throughout the study. The hydration status was stable from day 1 (Ht(2)/Rz: 64 +/- 13 cm(2)/Ohm in T and 59 +/- 12 cm(2)/Ohm in C subjects) to day 5 (66 +/- 11 cm(2)/Ohm in T and 61 +/- 13 cm(2)/Ohm in C subjects) in both groups. Two patients on steroid treatment showed a relative hyperhydration. Mean heart rate did not differ between T (135 +/- 10 bpm) and C (136 +/- 5 bpm) subjects throughout the study, although a reduction from day 1 to day 5 was observed in T subjects only (p < 0.05 vs C group). No differences were found between T and C group in walking velocity (1.7 +/- 0.6 km/h in T and 1.7 +/- 0.5 km/h in C group); mean intensity of physical activity was 3.4 +/- 0.5 METs in T and 3.3 +/- 0.6 METs in C group during each trekking stage. Negligible differences were observed in cardiovascular, metabolic and hydration status adaptations to desert trekking between selected T and C individuals. T subjects with creatinine clearance > 55 ml/min showed acceptable physical performance and acclimatization to desert environment, suggesting a good long-term outcome of transplantation.