Pushed by the ever-increasing demand of high-speed connectivity, next generation 400Gb/s electrical links are targeting PAM-4 modulation to limit channel loss and preserve link budget. Compared to NRZ, a higher amplitude is desirable to counteract the 1/3 reduction of PAM-4 vertical eye opening. However, linearity is also key, and PAM-4 levels must be precisely spaced to preserve the horizontal eye opening advantage it has over NRZ. This paper presents a 45Gb/s PAM-4 transmitter able to deliver a very large output swing with enhanced linearity and state-of-the-art efficiency. Built around a hybrid combination of current-mode and voltage-mode topologies, the driver is embedded into a 4-taps 5-bits FFE, and allows tuning the output impedance to ensure good source termination. Implemented in 28nm CMOS FDSOI process, the full transmitter includes a half-rate serializer, duty-cycle correction circuit, >>2kV HBM ESD diodes, and delivers a full swing of 1.3Vppd at 45Gb/s, while drawing 120mA only from 1V supply. The power efficiency is ~2 times better than previously reported PAM-4 transmitters.