So, distributed amps are made with a terminator on one end and input/output on the other. The input/output sides are swapped, so you get a propagating wave of amplification from one side to the other.
But you're still burning half your input and output in a terminator (well, roughly).
If there were such a thing as a wideband circulator, it would be reasonable to pass waves in both directions and therefore double (roughly) the efficiency, no?
Or even, roll it into a loop (toroidial amplifier?), and add a switch, so it acts something like a Q-switched laser gain medium, or something.
Going back to vacuum tubes (since they have the lowest input losses), the plates, grids and lumped transmission elements could even be distributed within a single tube, so that, as a high velocity electron beam shoots across it, each time the transmission line loops around the beam, it sucks a little more and a little more energy out of the beam, achieving amplification at very high frequencies!
;-)
Tim