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Cook pasta according to package directions. Drain, reserving ¾ cup pasta water.
Meanwhile, in a large skillet, saute sausage over medium heat until lightly browned; reduce heat to medium-low. Add pumpkin, cream, salt and pepper; cook and stir until heated through. Toss with pasta and enough pasta water to moisten; stir in cheese. If desired, sprinkle with cilantro.